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Bridging psychological and physical health care A special feature on paediatric clinical psychology
Incorporating Psychologist Appointments ÂŁ5 or free to members of The British Psychological Society
letters 170 news 178 book reviews 216 careers 236
interview with James Blair 212 the educational meets the evolutionary 246 George Kelly and the Garden of Eden 250 one on one with Martin Conway 252
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letters speaking out on the NHS; praise and criticism; Jon Driver; and more
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news and digest 178 beautiful explanations; mushrooms in a brain scanner; Little Albert; reports from the Division of Occupational Psychology; nuggets from the Digest; and more media 186 coverage from the Division of Occupational Psychology conference with Kisane Prutton; the Guardian memory experiment; and the best of the web
Bridging psychological and physical health care Konrad Jacobs, Penny Titman and Melinda Edwards introduce a special feature
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Adjusting to life with chronic illness Deborah Christie and Hasina Khatun
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Coping and acceptance in chronic childhood conditions Jeremy Gauntlett-Gilbert and Hannah Connell 198
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The ‘late effects’ of paediatric brain tumours Helen Stocks, Kate Ablett and Matthew Morrall
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Paediatric intensive care Gillian Colville on stresses and strains for families
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‘Patients with the disorder deserve to be helped’ An interview with James Blair from the US National Institute of Mental Health
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book reviews the organisation of the mind; longitudinal data analysis; the psychology book; and more
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THE ISSUE My son had an anaphylactic reaction when he was three years old. He was hospitalised for three nights, and this was just the beginning of a round of prick tests, ‘nut challenges’ and extreme day-to-day vigilance. It has been my biggest challenge, as a parent and person, and I’m sure it has been no picnic for him either. In this issue, we look at the challenges facing children and their families in adapting to chronic and life-threatening conditions, and how psychologists work across psychological and physical health services to support them. The emotional labour involved in this kind of work must be phenomenal, and I am filled with admiration for those shouldering that burden for the benefit of children and their families. I was particularly struck by the coping techniques suggested in Jeremy Gauntlett-Gilbert and Hannah Connell’s article, and I wonder if practitioners make use of these on themselves. Elsewhere, as usual I would encourage you not to miss the articles at the back of the publication, including a fascinating ‘Looking back’ on George Kelly and the Garden of Eden. Dr Jon Sutton
236 careers and psychologist appointments we talk to Angela Southall about her work for Midlands Psychology, and Robel Iyassu about working with challenging client groups; plus latest vacancies new voices
responding to the NHS listening exercise, in the President’s column; book award; practitioner of the year; measuring national well-being; online voting; latest from BPS journals; and more
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the educational meets the evolutionary, with Rachel Ingram in the latest in our series for budding writers looking back
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an interesting recurring theme in the later work of a famous personality theorist: Trevor Butt on George Kelly and the Garden of Eden one on one
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…with Martin Conway
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CREATIVITY Why do people in organisations find it so difficult to release themselves, to be creative? That was the question posed in an interactive session at the Division of Occupational Psychology conference with ‘miserably failed actor’ (his words) Andrew Mallett, from Mind Gym. When times are tough, Mallett argued, we really do need something different to survive. Drawing on examples such as Kuoni, who applied a ‘Tupperware party’ approach to the dwindling holidays market, Mallett showed how creativity can be simple and quick. Challenged with ‘oppositional thinking’ tasks such as ‘find the opposite of a new topping for a pizza’, the audience came to identify with Einstein’s famous maxim ‘If at first the idea is not absurd, there is no hope for it’. There were plenty of other examples from the business world too, including Google’s rule that all employees must spend 20 per cent of their time on projects outside their normal role. ‘Take a risk’, Mallett concluded. ‘Play – ask what would a child see, what would a comedian see?’ JS
LEADERSHIP Could C. Moustaka and colleagues, including Ian Bushnell at the University of Glasgow, be pioneering a new field of lifespan occupational psychology? Their poster asked ‘Leadership starts young: Do attachment style, personality and narcissism predict emergent leadership?’ Assessing late primary and early secondary school children during a visit to a science centre, the authors found that extraversion was the best single personality correlate of leadership, but that this was supported by experiences that may well include effective attachment. Aspects of so-called ‘narcissistic performance’, such as ‘I am very good at making other people believe what I want them to believe’, were associated with leadership performance on a ‘build a tower’ task. JS
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Working on the glass cliff Back in 2003, Michelle Ryan checked her pigeonhole and found an article from the business section of The Times in 2003, stating that the ‘triumphant march of women into the country’s boardrooms has wreaked havoc’ on companies’ performance. This was to be the spark for a line of inquiry that has borne years of fruitful research, and the story began her Division of Occupational Psychology conference keynote tour of the ‘glass cliff’. The term plays on the metaphor of the glass ceiling – the invisible limit which prevents women from making it to the top of organisations. The glass cliff is an invisible risk, referring to the experience of women who make it to senior positions, only to discover they are unusually precarious. Ryan began to perceive the glass cliff by scrutinising the claims of that newspaper article, deposited by an unknown friendly colleague. Historical data comparing 19 women appointed to the Board of Directors with a matched sample showed that appointments of women were indeed associated with slumps in share price, but that the slump preceded the appointment. The article had based its claims on a false assumption of causality, and it seemed instead that women were more likely to be appointed to companies in crisis. Ryan then used experimental investigations involving hypothetical situations. She asked participants to decide how they would fill a position, such as company finance director, by choosing between two similar candidates who differed in gender. When the position was presented within a stable context – a growing company, a winnable political seat – then the candidates were similarly favoured. However, when the situation was presented as one with a high chance of failure – a company in crisis, or an unwinnable seat – the woman was a far more popular selection. People even favoured a female youth representative for a festival that was experiencing declining popularity.
Perhaps women are seen as better crisis managers than men? (Ryan quoted Eleanor Roosevelt: ‘Women are like teabags. You don’t know how strong they are until you put them in hot water.’) In another study, participants judged that a company in a stable context needs a leader who was assertive, competitive or possessed other traits judged to be stereotypically masculine by other participants in a pre-study phase. Meanwhile, leaders in crisis situations should be understanding, tactful, creative – more stereotypically feminine. But what is it about crises that women are seen as suited for: taking control and improving performance, for instance? Not so; a follow-up that separated out different aspects of leading in crisis found female traits were only favoured for the purpose of soaking up criticism or enduring negative conditions. And another study showed that when the crisis situation had full support of senior leadership, there was no preference for women to take the role. The data suggests that women are preferred when the situation is not just risky but actively precarious, with likely negative repercussions for the situation and themselves. What are the consequences for female board members? Well, there is evidence that female CEOs have far shorter tenures, which may reflect the fact that such positions are often set up to fail. Ryan concluded that in the pursuit of equal opportunity, we shouldn't be misled by the raw numbers of women in leadership positions; the nature of the role matters just as much. In an interesting extension of her experimental work, Ryan and colleagues collected folk theories for the glass cliff via the BBC website. Women tended to believe that women are singled out for precarious positions, or that they have fewer opportunities and therefore accept riskier positions. The majority of men simply didn’t believe that women are differentially placed on the glass cliff. AF
NATIONAL CULTURE AND PERSONALITY If people of different nationalities score differently on a personality test, does this say something about national temperament, or simply that the test is biased? Dave Bartram took us through an interesting approach to this tricky issue: when ‘national differences’ in personality also correlate with other measures, we can be more confident they are the real deal.
Bartram worked with a big data set – one million participants all told – but as the correlations were made between countries, not individuals, they involved just 31 cases, a modest sample in which to detect patterns. He found that each personality measure correlated with one or more Hofstede dimension of national culture; for instance, emotional stability
tended to be higher in cultures that are less masculine, more individualistic, more tolerant of ambiguity, and have less power distance (meaning less acceptance of unequally distributed power). The next analysis was neat, correlating the cultural dimensions with the standard deviation of personality scores in each country – whether scores
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CULTURE EATS STRATEGY
You’re in the army now The British Army loses nearly one third of its recruits to attrition, many leaving during the first 14 weeks of training. Its size means reducing this figure by a percentage point could save almost £750,000. MOD psychologist Natalie Fisher investigated the nature of this early attrition, taking a multi-layered approach, speaking to recruits at various stages around the training period. In a series of five focus groups, Fisher drilled deeply into the experiences of successful trainees. She found that the majority had considered leaving at one point or other, due to missing their families or dissatisfactions, such as over basic wage levels. The reasons for pushing on were diverse, but commonly included the desire to serve overseas and a sense of not wanting to let the family down. The focus groups identified a critical period around week seven of training, which proved particularly challenging tightly clustered or showed large variation – rather than with their average levels. This made it possible to explore the idea that some countries are culturally ‘tighter’ than others, giving less scope for individual difference. The analysis picked up several such effects. The higher the power distance of a culture, the more uniform its members were in terms of measures like agreeableness, conscientiousness or extroversion; the reverse was
for leavers: this was the time when they were least likely to feel like a soldier or have a sense of belonging. It's probably no coincidence that this period coincides with the weekend home and the chance to catch up with the world left behind… Interviewing recruits who left during training, Fisher found negative reasons for joining up, such as ‘no career options’, were more frequent than for those who stayed through training. The latter group more often cited being driven by expectations and having family support. The interviews with leavers also identified they were much more likely to feel homesickness from the first week in training onward. Fisher pointed out that the psychological literature on this is problematic, as it focuses on students and children away at camp, and may not be generalisable. Certainly, some of the recommendations from that research, such as ‘get enough sleep’, aren’t entirely
true for countries high on another measure, individualism. Correlation of personality with culture ratings might not strike you as objective enough to produce a verdict; perhaps they are both subject to a common confound. But how about correlations with hard measures such as GDP, life expectancy, UNESCO education index and the UNDP human development index? These measures were all found to correlate with standard deviations of personality scores,
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compatible with the training experience. However, the advice to establish solid routines and ensure access to someone to speak with are pertinent. The study raises many questions: for instance, of those who were recruited but never even made it to training, some had concrete reasons, such as illness or family need, but one third simply changed their mind at the last minute. Why? And Fisher spoke to training instructors, who identified some perceived characteristics of those who left, such as a dislike of discipline, but conceded many exits were simply unpredictable. Were they not getting something they were looking for in the role? Like most organisations, the British Army wants to warn off applicants who would be a poor fit, but also to prevent avoidable attrition of people who could have ultimately been a success in the role. In such high-stakes positions, this is a true balancing act. AF for instance high GDP was related to larger ranges of openness to experience in the population. This study doesn’t answer whether national culture shapes typical personality or vice versa, although it’s useful in honing hypotheses. But this cascade of correlations does suggest that personality differences between countries, although they are small, reflect something real, rather than meaningless measurement error.
‘Culture eats strategy for breakfast: the tale of a nomadic storyteller’ was the intriguing title of a talk from Trixy Alberga, Head of Culture Change at the Highways Agency. Based on a comment made to her, the title reflected the belief that ‘culture is more powerful than strategy, since it reveals how things are actually done, whether or not this was intended’. The Highways Agency, part of the Department for Transport, promotes the more effective use of the strategic road network by addressing the causes of congestion and unreliability. A large workforce, with mixed backgrounds including culture and preferences brought from previous organisations with powerful cultures, led to clear challenges for Alberga. She reported that engagement scores had suggested there is real room for improvement, especially in leadership at all levels; there were persistent rumours and some data about behaviours regarding diversity; and a greater number of grievances, complaints and sickness than desirable. Alberga recounted her struggle to tackle the ‘multitude of conflicting stories’ around the organisation’s culture and systems. In attempting to agree a new vision, Alberga has worked towards ‘one story to unite all’. The result – ‘we take professional pride in keeping our roads moving safely’ – is currently the subject of debate, but it was fascinating to hear Alberga describe the occupational psychology behind the choice of each word. Supporting this was a range of interventions including a diary study of how people actually feel about the communications they receive; a ‘back to the floor’ scheme for senior management; and new performance data to include cultural features. ‘Still talking’, concluded Alberga, and these stories from someone making sense of a major and complex organisation were well worth hearing. JS
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A fair share of the housework More women than ever go out to work, and yet surveys in Western countries show that wives continue to take on the lion’s share of domestic chores. A new study has quizzed 389 couples in Austria, Germany and Switzerland to build up the most comprehensive picture yet of how this uneven distribution of domestic chores is associated with men’s and women’s marital satisfaction. These were all dual-earning couples with young children, with both spouses working at
In Personal Relationships
least 15 hours per week; 89 per cent of the couples were married. The average professional workload for women was 30.2 hours per week; for men it was 48.6 hours. Consistent with past surveys, the women in this sample took on nearly two thirds of the domestic chores. The researchers, Gerold Mikula, Bernhard Riederer and Otto Bodi, asked their participants several things: what share of the chores they took on; whether they thought that was fair; whether they felt the way the share had been decided was fair (so-called ‘procedural justice’); how much conflict they experienced in their relationship; and how happy they were with their relationship. They threw all these factors into a statistical pot and looked to see how they related to each other. First, Mikula and co. focused only on the
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direct associations between housework distribution and women’s and men’s answers. For women, it wasn’t the precise share of housework they did that was correlated with their experience of conflict and satisfaction, but rather how fair they thought that share was. Women who thought the division of household chores was unfair tended to experience more relationship conflict and less marital satisfaction. Women’s sense of whether the decision process for housework had been fair also had its own independent link with levels of conflict. So feeling that they did an unfair amount of housework was bad enough, but conflict was even more likely when women felt the unfair arrangement had been arrived at unfairly. Men, by contrast, seemed largely detached from the way housework was shared. There was no direct correlation between the division of housework and their reports of fairness. And even men who said the arrangement was unfair didn’t tend to report more relationship conflict or less satisfaction – no doubt because the unfair arrangement was usually in their favour. In fact, the only direct association of housework distribution with men’s answers, was that the greater share their female partners took on, the more satisfied they tended to be. But here’s where the picture gets more complicated. The researchers also looked at associations between participants’ answers and their partners’ reported sense of justice and experience of conflict and satisfaction. This suggested that men suffered when their female partners believed the housework arrangements were unfair. In fact, the negative correlates for men (more conflict, less satisfaction) of having a female partner who sensed injustice in the division of housework, outweighed the satisfaction associated with having a female partner who did lots of housework. ‘The results support the proposition that it is not the balance of the division of labour itself but rather the subjective sense of justice associated with the division that matters primarily to the relationship satisfaction of the persons concerned,’ the researchers concluded. ‘Spouses should exchange their personal views and preferences in open discussions to arrive at an agreement that considers the wishes of both parties…’
Bring on Barry White In Social Psychological and Personality Science As a rule, big beasts tend to make deep noises, whereas little creatures squeak. Perhaps it’s little wonder then that we tend to rate human speakers with deeper voices as more powerful, or that if you put a person in a position of power they will tend to lower their voice. These previous results prompted Mariëlle Stel and her fellow researchers to find out if speaking with a deeper pitch than usual would lead people to feel more powerful. In an initial study, 81 student participants were split into three groups. Participants in the control group read a passage of geography text silently to themselves. The other two groups read the text out loud, either in a deeper or higher pitch than usual (by three tones). To make sure the participants didn’t guess the true aims of the study, the students were next asked some filler questions about the text. The final stage was then presented as being unrelated to the reading exercise. This involved the students answering seven questions about how powerful they felt (for example, indicating how much they felt dominant versus submissive). None of the students guessed the purpose of the study. Reading the text with a deep voice didn’t affect the students’ answers to the questions about the text, but it did appear to affect their feelings of power. Students in the deep voice condition rated themselves as more powerful than students in the other two groups.
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A second study was similar, but this time students read some text in a high or low pitch, or they heard someone else doing the reading with a high or low pitch. Only reading the pitch oneself affected feelings of power, with students who read in a low voice rating themselves as more powerful than students who read in a high voice. One last study involved reading out loud in a deep or high voice, and then the participants completed a memory task that’s designed to reveal abstract thinking (mistakenly believing a word was seen in an earlier to-beremembered list, just because it has a similar meaning to one of those earlier words, is taken as a sign of more abstract thinking). This time, reading out loud in a deep voice led to more abstract thinking. Stel and her colleagues said this makes sense when considered alongside an earlier study that found people in power tend to think more abstractly than low power people, perhaps because power makes people feel more ‘psychologically distant’. Throughout these experiments, the effects of lowering one’s voice pitch on feelings of power were presumably subconscious. The researchers said it would be interesting for the future to see if it’s possible to deliberately lower your voice in order to feel more powerful. ‘If so,’ they concluded, ‘this would add a simple and generally available instrument to your strategic arsenal: your own voice. The lowering of your own voice could then be used not only to influence others but also to influence yourself.’
You’re most creative when you’re at your groggiest In Thinking and Reasoning, tinyurl.com/82436tx Are you an evening person? Guess what? Early in the day, when you’re bleary eyed, stumbling about in the fog of sleepiness, you’re probably at your creative peak. In contrast, if you’re a morning person, then for you, the evening is the best time for musing. How come? Insight-based problem solving requires a broad, unfocused approach. You’re more likely to achieve that ‘Aha!’ moment when your inhibitory brain processes are at their weakest and your thoughts are meandering. Mareike Wieth and Rose Zacks recruited 428 undergrads and had them complete a questionnaire to identify whether they were night owls or morning larks. As you might expect, based on factors like preferred time of day and peak performance, most of the students – 195 of them – were owls and just 28 were larks. The rest came out as neutral. Next, the students tried to solve six problem-solving tasks – half of them were insight-type tasks (e.g. a prisoner in a tower finds a piece of rope that’s half the length of the distance to the ground. He escapes by using scissors to divide the rope in half and then tying the two ends together. How could he have done this?), and half were analytic questions that require a narrow focus (e.g. Bob’s father is three times as old as Bob. They were both born in October. Four years ago, he was four times older. How old are Bob and his father?). Students had four minutes to solve each problem.
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Crucially, half the students were tested between 8.30am and 9.30am, the others were tested between 4pm and 5.30pm. Here’s the headline result: the students were much more successful at solving the insight problems when the time of testing coincided with their least optimal time of functioning. When larks were tested in the evening and owls were tested in the morning, they achieved an average success rate of 56, 22 and 49 per cent, for the three insight tasks, compared with success rates of 51, 16, and 31 per cent achieved by students tested at their preferred time of day. By contrast, performance on the analytic tasks was unaffected by time of day. A potential weakness in the findings is that there were so many more evening people among the student participants (who therefore excelled at the creative tasks in the morning). So perhaps the results were skewed and the creative
advantage has to do with the morning, not to do with performing at your least favoured time of day. To test this possibility, Wieth and Zacks looked at the data for the students with no favoured time of day. They didn’t perform the insight tasks any better in the morning than evening, thus suggesting the creative advantage specifically comes from operating at your least optimal time of day. The researchers recommended that students consider designing their class schedules so that they take art and creative writing at their non-optimal time of day. ‘Students tend to get higher grades when classes are in sync with their circadian arousal; however, the interaction between time of day and type of class has not been investigated… the relationship between time of day and grades needs to be investigated and may not simply follow a uniform pattern.’
The material in this section is taken from the Society’s Research Digest blog at www.researchdigest.org.uk/blog, and is written by its editor Dr Christian Jarrett. Visit the blog for full coverage including references and links, additional current reports, an archive, comment and more. Subscribe by RSS or e-mail at www.researchdigest.org.uk/blog Become a fan at www.facebook.com/researchdigest Follow the Digest editor at www.twitter.com/researchdigest
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Never judge a piece of research by its abstract Reflections from Kisane Prutton, a bingo-playing conference press officer his year’s Division of Occupational T Psychology Annual Conference proved to be a bumper year for press coverage,
financial crisis was still the same, in crisis. To be perfectly honest, I was less than optimistic in the months leading up to with, to date, well over 100 pieces in our Christmas deadline. I had started to print, online, on the radio worry when and on TV. Had my tea selecting papers leaves been read in the run for the conference up to the event, they would at the DOP have predicted a modestly programming successful outcome. So meeting in what happened and why September, because were we so fortunate? I could see that First, we had a quite a few tremendous conference submissions had programme; and second, not analysed their the timing was spot on. The data yet. How on DOP Annual Conference earth could we takes place in the shadows anticipate what of Christmas, in the second was going to be week of January. This year newsworthy? the news was pretty quiet; By November Angela Merkel – Bingo!? thankfully Kate Middleton I had selected my had not appeared in any long-list, which more high street frocks, shrunk to a shortBritain had not ground to a halt under an list by the time we took out those papers unexpected snow flurry and the global without data and those whose authors had chosen to decline the offer of presenting in poster format. It is unfortunate that people perceive posters as second-class citizens – from a newsworthy perspective we often find a good percentage of innovative material Psychologist Stephen Joseph on trauma and here. Perhaps next year we could call it the Zeebrugge disaster the Pioneering Research section. http://t.co/2fkT1YE1 Conferring with Jonathan Calder Will Scots vote to leave UK? Social psych from the BPS’s Media Centre, we agreed analysis from Dominic Abrams and Peter on five pieces of research that were likely Grant http://t.co/r1gXGQgy to resonate with the public: Sandi Mann’s Lads’ mags, sexism and research in poster: ‘A Mars a day keeps the boredom psychology: an interview with Peter away’, Gail Kinman’s interactive paper: Hegarty http://t.co/wsrz8vjH ‘Work-linked couples and work–life Jonathan Haidt decodes the tribal balance’, Rob Bailey’s poster: ‘Will you psychology of politics http://t.co/uyjSoFlg look at my CV, or my pictures on Psychologist Greg Feist on what drives Facebook?’, Rich Balding’s poster: ‘The scientific curiosity http://t.co/NskS5tu4 relationship between smart phone use 50 years of pupillometry http://t.co/0XDRwFbr in the workplace and stress levels’ and Cristina Quinones-Garcia’s short paper:
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MEDIA PRIME CUTS
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The Media page is coordinated by the Society’s Media and Press Committee, with the aim of
promoting and discussing psychology in the media. If you would like to contribute, please contact the ‘Media’
page coordinating editor, Ceri Parsons (Chair, Media and Press Committee), on c.parsons@staffs.ac.uk
‘The emotional effects of service with a smile’. The next four weeks were hectic – drafting the media releases, ensuring the authors and their press offices were happy, plus fitting in my day job, attending to family and preparing for Christmas. It was on one of my increasingly regular trips to Santa’s food grotto that my phone rang. It was Geoff Trickey. Geoff had submitted a paper to the conference and had it accepted, but he was surprised that it had not been selected for media coverage. ‘Understanding the link between personality and risk tolerance’ had caught my eye back in September... Nick Leeson, bankers, bonuses, all the usual clichés sprung to mind. 45 minutes later, from the cramped, shopping-bagfilled cockpit of my Mini, we found it – the sweet spot. Geoff’s research suggested that women make better leaders than men during economic crises due to their riskaverse personalities. ‘Bingo’! So it came to pass that a new media release was borne. Fast-forward to January, the risk prone personality ‘story’ hit the news big time. Accompanied by the gleaming face of Angela Merkel, the research was a conduit to promote the Society and UK psychologists to audiences as far and wide as Canada, India and the United Arab Emirates. Encouraged by our success, we tried the formula again, mid-conference. Unsuspecting abstract, interesting topic, data to riffle through and ‘Bingo!’, again. ‘Office workers spend too long at their desks’ emerged from Myanna Duncan’s interactive paper: ‘Occupational health provision: The challenges of the ageing population’. Jersey, Dallas, New York... if only we could go and collect the press clippings in person! And the point of this article? Very often there are hidden gems in research which can be missed or overlooked. To promote Psychology-Team-GB, we need to be vigilant on the conference circuit and consider how our findings might serve our public audience, not just our academic community. We need psychologists who are brave enough to engage with the media, with research that holds meaning for the daily lives of everyday people. I am not for one moment suggesting researchers sell their souls and bastardise their life’s work in order to satisfy the public’s unrefined appetite, far from it. I am simply saying that in the name of Team-GB, we should look to nourish both an academic and lay audience and it may be possible with different elements of the same piece of research. In other words, more ‘Bingo!’.
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A modern-day witch-hunt? ‘The hounding of 'Psychic Sally' is hunters of old: first, by a desire to look becoming a modern-day witch-hunt’, big and impressive by shouting down an claimed the headline of a Telegraph piece allegedly wicked woman; and second, by by Brendan O’Neill (see a desire to save the little people, who are tinyurl.com/7h2b8o7). daft and easily led, from having their For those not familiar with the story, minds warped and their lives wrecked by Sally Morgan is a TV psychic who is people who believe in things the rest of us demanding damages of £150,000 from don’t believe in.’ Associated Newspapers over a Daily Mail I asked Professor French about this, story by magician Paul Zenon, accusing and he said: ‘There are crucial differences her of scamming a vulnerable between the persecution audience. The article, of innocent women falsely published on 22 September, accused of being witches was headlined: ‘What a load of and criticism of a woman crystal balls!’, and it alleged who has made millions of Morgan pretended to have pounds by herself claiming psychic powers when she was to be able to talk to the in fact simply repeating dead. If she really does information from members of have such powers, it her team via a microphone and would be the most hidden earpiece. amazing discovery ever Morgan was subsequently and she should be willing invited to prove her to be tested under supernatural powers in a controlled conditions. If she ‘She should be Halloween test devised by doesn’t, she’s a fraud willing to be tested’ psychologist Professor Chris exploiting the bereaved and French, Head of the nothing more.’ Anomalistic Psychology Research Unit at I am in complete agreement with Goldsmiths, University of London. When Professor French here. Yet I do she inevitably failed to show, Morgan was occasionally feel a twinge of unease at the heavily criticised on Twitter. speed, volume and ferocity of response O’Neill appears to have taken issue the sceptical scientific community appear with this, writing: ‘Why are ostensibly able to marshal. Perhaps there is a grain intellectual people devoting so much time of truth in O’Neill’s caution that ‘the and energy to having a pop at a woman fashionable secular set seems incapable who claims to be psychic? … The antiof asserting itself in any positive way’, and Morgan lobby is motivated by the same we should be particularly wary of social impulses as those pointy-hatted witchmedia in this context. JS
Memory bonanza The Guardian and Observer held a themed Memory Week in January, part of the papers’ Head Start self-help series for 2012 (see tinyurl.com/maximem). This included a mass participation online experiment run by psychologists Jon Simons, Zara Bergström and Charles Fernyhough, looking into long-term memory and how the similarity of events affects remembering. In three weeks, over 27,000 people took part. ‘It was great fun collaborating with The Guardian,’ Simons told us. ‘Thanks to lots of publicity by them, and hundreds of people sharing and re-tweeting the weblink around the world, we had an extraordinary response. We’re currently immersed in processing these data, and hope to publish a preliminary report on the findings soon.’ Another feature was a live, online Q&A session with Charles Fernyhough. ‘That was a very new experience,’ Fernyhough said. ‘It showed me that a lot of people think of memory as a muscle that needs to be strengthened, rather than this fascinating and tricky process of self-editing that the research is telling us about.’ The week culminated in publication of a special two-part supplement coordinated by Fernyhough, which included contributions from him on autobiographical memory and shared memories; from Simons on the science of remembering; Hugo Spiers on the neurobiology of memory; Alice Bell on the effect of the internet; Ed Cooke with mnemonics and memory tests; and me on memory myths and glitches. CJ
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MEDIA CURIOSITY New York – the city that never sleeps. Perhaps that’s why taxis are to be fitted with ‘honk-reduction technology’ (http://t.co/MeGiq1BA). It seems that enormous signs reading ‘Don’t Honk – $350 fine’ are not enough. ‘Give someone a horn and they’ll honk it,’ writes Josh Max in New York Daily News. So why are New Yorkers such brats behind the wheel? ‘It’s frustration,’ says environmental psychologist Dr Arline Bronzaft. ‘Nothing moves if you’re stuck at the back end of a line of cars and you honk your horn. Rationally, we know this. But are people rational beings? No – they’re emotional.’ Yet despite the impact of noise on quality of life, most drivers like their horn nice and loud. During a press launch for the Hyundai’s Sonata, there were overwhelming complaints about the car’s wimpy horn. Within a week, Hyundai replaced the hardware with a ‘more appropriate dualshell unit that gives the car a louder presence when the owner needs to use the horn’. Despite this, a new Nissan taxi is to be fitted with honk-reduction technology, ‘specifically a so-called low-annoyance horn’. Bronzaft recommends training drivers to control their tempers. ‘Take a deep breath, hum a song. Say to yourself, “How best could I deal with this situation?” Or why not see if we can come up with something imaginative? Why not a horn you can restrict? If you hit the horn, say, 2–3 times, then it quits. Or design a mechanism whereby when you put your hand down for any length of time, the horn simply stops. And then it won’t go on again for a period of time. At least let’s stop the horns from continuous, unrelenting blasts.’ JS
MEDIA TRAINING 12 March Intro to media www.bps.org.uk/events/media-trainingintroduction-working-media £200 +VAT (BPS) 30 April Broadcast www.bps.org.uk/events/media-trainingbroadcast-interview-skills £300 +VAT (BPS) Contact learningcentre@bps.org.uk
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ARTICLE
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Bridging psychological and physical health care Konrad Jacobs, Penny Titman and Melinda Edwards open a special feature on paediatric clinical psychology Michael is six years old. He has recently been diagnosed with an aggressive form of juvenile arthritis. He needs to have monthly blood tests, and weekly methotrexate injections, which make him feel sick for a day. Sometimes he gets sick even before he has taken his medication. It takes more than two hours for Michael to have his injections because he tries to negotiate and delay. When that fails, he cries, shouts and eventually even hits, bites and kicks. His mother gets upset and tearful, while his father tends to get more and more angry and authoritarian.
questions
How can we use psychological theories and techniques to improve physical and psychological health in children with physical health problems?
resources
British Psychological Society (2003). Briefing paper: Child clinical psychologists working with children with medical conditions. Faculty for Children and Young People BPS, UK. Edwards, M. & Titman, P. (2010). Promoting psychological well-being in children with acute and chronic illness. London: Jessica Kingsley. www.ppnuk.org: UK Paediatric Psychology network
references
Children who have a physical health problem are more likely to successfully manage the challenges presented by their medical condition if their health care addresses both their physical and psychological well-being. Whilst physical health services and psychological services have traditionally been provided by different organisations, paediatric clinical psychologists work across these services to improve both physical and psychological outcomes. This article describes some of the clinical work carried out by paediatric psychologists and the systems within which they work.
Channon, S.J., Huws-Thomas, M.V., Rollnick, S. et al. (2007). A multi center randomised controlled trial of motivational interviewing in teenagers with diabetes. Diabetes Care, 30, 1390–1395. Chiles, J., Lambert, M. & Hatch, A. (1999). The impact of psychological interventions on medical cost offset. Clinical Psychology: Science and Practice, 6, 204–220.
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Alice (13) has widespread idiopathic chronic pain syndrome. She frequently attends her GP surgery, paediatrician and local A&E department. There is no medical treatment for her condition. She has stopped going to school, has limited mobility, uses crutches, has disrupted sleep, panic attacks and low mood. Her mother has had to give up her job to care for Alice. The family have had to adapt completely to Alice’s disability.
C
hildren with acute or chronic medical conditions such as these find themselves in unexpected, unfamiliar and unwanted territory. Children often become distressed, angry, sad or worried in relation to their physical condition. Parents in their own right can find it difficult to manage both the child’s emotional response and their own reaction
Department of Health (2004). NSF for Children – Standard for Hospital Services. London: HMSO. Duff, A. & Bryon, M. (2005). Consultation with medical teams. Clinical Child Psychology & Psychiatry, 10, 102–111. Edwards, M. & Titman, P. (2010). Promoting psychological well-being in children with acute and chronic illness. London: Jessica Kingsley Publishers. Edwards, M. (2010). Directory of paediatric
to their child’s condition. Paediatric psychologists (and other psychosocial professionals) help children and their families navigate a way through the difficulties towards a desired solution. A widely used definition of the field of paediatric psychology is ‘a field of research and practice that has been concerned with a wide variety of topics in the relationship between the psychological and physical well-being of children, including behavioural and emotional concomitants of disease and illness, the role of psychology in paediatric medicine, and the promotion of health and prevention of illness among healthy children’ (Roberts et al., 1984). The challenge for psychosocial professionals working in paediatrics is to ‘maximize health outcomes, minimize the emotional consequences of living with chronic disease and improve the quality of life for children, young people and their relatives’ (Duff & Bryon, 2005). Paediatric psychology in the United Kingdom has grown out of various psychological traditions, including adult health psychology, child clinical psychology, educational psychology, developmental psychology and paediatric neuropsychology. We still draw upon all these models to provide our services. Paediatric psychologists became gobetweens between mental and physical health: skilled communicators who hold two different languages, medical and psychological, and who advocate for a psychosocial focus in paediatric medicine. This generally quite amicable relationship (with its ups and downs) between paediatric medicine and psychology has led to a continuing growth of the field of paediatric psychology over the last 30 years. In addition, this growth has been maintained by: I A growing move towards patient-centred care (Edwards & Titman, 2010), as evidenced by Standard 7 of the National Service Framework for Children (DoH, 2004): ‘Attention to the mental health of the child, young person and their family should be an integral part of the children’s service, and not an
psychology services across the UK, 2009–2010. Unpublished survey. Ellis D, Naar-King, S, Frey, M. et al. (2005). Multi-systemic treatment of poorly controlled type 1 diabetes. Journal of Pediatric Psychology, 30, 656–666. Kazak, A.E. (1997). A contextual family/systems approach to pediatric psychology. Journal of Pediatric Psychology, 22, 141–148.
Roberts, M.C., Maddux, J.C. & Wright, L. (1984). The developmental perspective in behavioural health. In J.D. Matarazzo et al. (Eds.) Behavioral health (pp.56–68). New York: Wiley Roberts, M.C. & Steele, R.G. (2009). Handbook of pediatric psychology. New York: Guilford Press. Spirito, A. & Kazak, A. (2006). Effective and emerging treatments in pediatric psychology. New York: OUP.
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afterthought… It is therefore essential for a hospital with a children’s service to ensure that staff have an understanding of how to assess and address the emotional well-being of children.’ I The wider availability of (evidence-based) national guidelines (e.g. NICE; Cystic Fibrosis Trust; Arthritis and Musculoskeletal Alliance) which include recommendations for the addition of psychological services in the commissioning of medical services. I A better understanding of the psychosocial impact of medical conditions on children and families and the fact that users of health care The most prevalent model for these services is for psychology often perceive the to be based in the hospital setting and to be integrated within psychosocial issues to the various multidisciplinary health teams be as important as the medical issues. I Validation of the role of problems. The first paediatric psychology psychology in paediatric medicine: conference in the UK was organised in interventions improve not just 1999, in Bath. The Paediatric Psychology psychological but also health outcomes Network (see www.ppnuk.org) was (Roberts & Steele, 2009; Spirito & established soon after through the efforts Kazak, 2006). of a number of experienced clinicians. I Psychological interventions that The Network became an official part of can potentially significantly reduce the British Psychological Society’s Faculty healthcare costs. A controlled trial of for Children and Young People in 2006. multi-systemic therapy for diabetes A national survey conducted in 2009 demonstrated reduced inpatient (Edwards, 2010) found that there were admissions and significantly lower approximately 340 paediatric care costs for adolescents with poorly psychologists working in the UK in controlled diabetes (Ellis et al., 2005). health care with families of children Within an adult context, Chiles et al. and young people with acute or chronic (1999) estimated following a metaillness and disability (230 whole-time analysis of psychological interventions equivalent posts), distributed across 90 that the medical cost offset was around psychology services. The largest services 20 per cent. are based in specialist children’s hospitals, teaching hospitals and linked to Paediatric clinical psychology healthcare provision providing regional in the UK and national services. In other areas, often Clinical psychologists have worked in in district or general hospitals, clinical hospitals with children and families for psychology input is provided as part of a decades, initially often as a sub-specialty liaison or mental health service, with less of children and young people’s dedicated psychology time to health care. psychology services. Whilst numbers The most prevalent model for these were low in those days, the field has services is for psychology to be based in increased exponentially over the last the hospital setting and to be integrated two decades, and is in fact still growing. within the various multidisciplinary health Practically all paediatric psychologists teams. The advantage of this model is that are clinical psychologists who have it increases the visibility and presence of specialised in working with children and psychology within the healthcare young people with clinical health environment and encourages psychological
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thinking within healthcare teams. It also improves communication between team members and facilitates joint working, both clinically and in research. When psychological services are seen as part of the healthcare team and part of the holistic care the team offers, it makes psychological services more accessible and acceptable to children and families. This can be particularly important when families might be ambivalent about the need for, or social acceptability of, receiving psychological help. The survey showed there were at least 26 medical areas or specialties that had some dedicated psychological input, covering a wide range of acute, chronic and palliative conditions, with the greatest input to specialist medical services such as oncology, cleft lip and palate and diabetes. It was evident that there was little equity or uniformity to the distribution of psychology services in health care across the UK. Historically, services have developed according to the interests and value placed on psychological care by paediatric medical consultants, or by local healthcare targets, financial opportunities or bids. Increasingly, services are being developed as a result of hospitals meeting standards of care set by Department of Health policies or national guidelines indicating good practice. In addition, parent and local (or national) support groups have also exerted influence, or provided funds to develop psychology posts. The Scottish Government has made some financial investment in the development of paediatric psychology services in Scotland over the last three years as part of a National Delivery Plan.
What do we do? Paediatric clinical psychologists, like many other clinical psychologists, work both directly with children and families, and indirectly, by providing consultation and supervision to other professionals. In some specialties, such as cleft lip and palate, cystic fibrosis and bone marrow or organ transplant, psychological assessment is carried out as part of an agreed treatment protocol and is considered a routine part of the management of the child’s health condition. The aim of protocol-based assessments is to identify children and families likely to be at increased risk of developing psychological difficulties, in order to offer preventative intervention, or to identify those children and families who are likely to need increased input
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during medical treatment. This approach can also help normalise psychological input and may improve uptake of psychological intervention. The sorts of referrals made in child health settings do not always fit easily into the diagnostic categories used for child mental health difficulties: I Preparation for medical procedures I Promoting adherence to treatment I Symptom management, for example pain management I Managing trauma, including working with siblings and other family members I Bereavement work and support for grief and loss I Preparation and support for transition to adult services I Assessment and management of medically unexplained symptoms I Assessment and management of anxiety or low mood I Difficulties adjusting to diagnosis. Very few children referred with issues like these would reach the threshold for diagnosis of a psychiatric disorder as defined in ICD 10 or DSM IV. This prompted Kazak (1997) to say: ‘Families facing serious paediatric illness are essentially ordinary families facing extraordinary stressors.’ Most paediatric psychologists work by developing a formulation (based on gathering information from a variety of sources) about why the child or family has developed the current difficulties, identifying risk factors, any trigger events that may have precipitated the current situation, and any maintaining factors. A collaborative intervention plan is then
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developed with the child, the family and the medical team, based on the knowledge of the medical condition and any evidencebased interventions that are relevant to the child’s difficulties. For example, with Michael who we met at the start of this piece, it would be important either to observe a session where he is given his injection or to get a very detailed description from all of those involved for a clear shared picture of how this situation is managed, and what factors contribute to the escalation of his difficult behaviour. Whilst injections are inherently unpleasant for children, the current situation is becoming increasingly traumatic for all members of the family and this is probably contributing to the avoidance and anxiety that accompanies each procedure. His parents may have very different beliefs about how to manage these situations, which are likely to be linked to their beliefs about the illness and treatment and their own emotional reaction to Michael’s difficulties. For some conditions, there is an established evidence base regarding effective interventions, for example, CBT for the management of headache (Spirito & Kazak, 2006) or the use of motivational techniques for addressing difficulties with adherence in adolescents with diabetes (Channon et al., 2007). In some situations it is possible to draw on the use of techniques that have been developed for general difficulties and adapt these to the child’s situation. However, in common with many areas of psychological work, the evidence base is still quite limited and clinicians rely on creative adaptation of psychological techniques and clinical experience.
Indirect work often includes attending regular psychosocial or multidisciplinary team meetings, where the psychological and social needs of the children and families can be considered from different professional perspectives. These meetings provide excellent opportunities to influence the team’s thinking about families across the spectrum, not just those with high psychological needs, but also those families who are coping well. One of the advantages of these meetings is that this reduces the barriers between physical and psychological models of care and facilitates communication about the child’s care (Duff & Bryon, 2005). Many other professionals work with children in hospital (for example, play specialists, physiotherapists, social workers, teachers, etc.); joint case discussion and shared formulation provides an opportunity to enhance every professional’s approach and care of the child. When this works well, it provides a forum for planning holistic multidisciplinary interventions and can ensure that a wider range of children and families benefit from a psychological perspective on their care.
Challenges One of the challenges that needs to be addressed by psychology services is ensuring greater equity and access to psychological support across all illness groups and across all healthcare provision. This can be supported in part by increasing the capacity of a range of healthcare staff in a range of psychosocial interventions and by developing and making available effective psychological resources (leaflets, websites, good practice guidelines, DVDs and other media resources). Greater access to psychological input can also be supported at a more strategic level by communicating more effectively with commissioners about the ‘added value’ that psychological care brings to health care, in terms of health outcomes, satisfaction with services and well-being, and by contributing to national guidelines and policies about evidence-based and quality indicators for paediatric health care. Within the NHS, all services are required to meet targets for efficiency and effectiveness, including clinical outcome and cost-effectiveness. The Paediatric Psychology Network is actively exploring and piloting clinical outcome measures that are meaningful and sensitive to the particular challenges of illness and disability in childhood and adolescence. Most outcome measures that are currently available have been developed within child
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mental health or adult health services. Unfortunately, many of these measures have poor face validity for families where children have serious medical conditions, and are not sensitive to assessing change in this context. Some paediatric psychology services in the UK are utilising these outcome measures whilst more tailored ones are being developed. The most informative outcome measures are those that are able to measure change for the individual child based on their goals and needs, and those of the wider system around the child including family and healthcare team. A further challenge is to be able to communicate the effectiveness of the wider psychology roles that are highly valued by healthcare teams, including enhancing team communication and cohesion, consultation, staff support and supervision. Services have often been assessed on measures such as clinical activity, patient satisfaction and patient outcome, with less understanding and focus on this wider systemic role, which is harder to quantify. There is increasing recognition that psychological input can improve psychological and health outcomes for children with a chronic illness and there is a growing evidence base for the
effectiveness of particular psychological interventions in health care. In the current financial climate there is both a clear need and interest in quantifying the cost of illness and medical care and the cost effectiveness/benefits of psychological input. For example, calculating the cost of a surgical procedure that has been cancelled due to a highly distressed child who is unable to cooperate, and comparing this with the cost of specialist psychological support and preparation for the procedure. A cancelled surgery slot amounts to thousands of pounds, possibly a further stay in hospital with the associated costs of rescheduling the procedure, let alone the distress for the child, family and healthcare team and any direct health consequences of a delay in treatment. For other children, the costs of non-adherence can have significant healthcare costs in terms of less effective medical management and impact on health with the likelihood of increased medical appointments to monitor and ensure appropriate treatment. This is an area that has not been tackled sufficiently by paediatric psychologists yet. The challenge for psychology in health care is to be able to provide and evaluate highquality and evidence-based services as well
as understanding the value placed on the service by managers and commissioners, which includes the added value in terms of cost-effectiveness, and to communicate outcome effectively in all of these areas.
Konrad Jacobs is at the Department of Paediatric Psychology, Children’s Hospital, Oxford kjacobs@nhs.net
Penny Titman is at the Great Ormond Street Hospital, London Penny.titman@gosh.nhs.uk
Melinda Edwards is at the Evelina Children’s Hospital, London Melinda.edwards@gstt.nhs. uk
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LOOKING BACK
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George Kelly and the Garden of Eden Trevor Butt finds an interesting recurring theme in the later work of the famous personality theorist
G
references
eorge Kelly is recognised as one of ‘action’, and Kelly called ‘construing’. the great personality theorists of the Kelly’s fundamental postulate states that mid-20th century. Most a person’s processes are psychologically introductory texts in personality pay ‘channelised’ by the way in which he or tribute to Kelly as the inventor of personal she anticipates events. The way in which construct theory (PCT), which elaborates we anticipate things is through our how each person’s action can only be construing. understood in terms of his or her system Following the publication of The of meaning. Less well known is his career Psychology of Personal Constructs, Kelly after his success with The Psychology of became a key figure in the development Personal Constructs (1955). of clinical psychology in the USA. He was Accounts of Kelly’s work often give invited to speak all over the country and the impression that his contribution to embarked on a world tour in 1961. Many psychology was to somehow preserve the importance of cognitive psychology during the arid days of behaviourism. It is as though ‘personal constructs’ were a prescientific way of talking about cognitions. In fact, personal construct theory is firmly grounded in philosopher and psychologist John Dewey’s pragmatism (Butt, 2005, 2008; Cromwell, 2011; McWilliams, 2009; Warren, 2010). Like Dewey, Kelly clearly and emphatically rejected Cartesian dualism, and along with it the division of ‘a person’s processes’ into cognition, emotion and behaviour. All three are subsumed in what The story of Eden being about original sin – a relatively recent Christian variant – is what interested Kelly Dewey (1931/1982) called
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Armstrong, K. (2006). A short history of myth. Edinburgh: Canongate. Butt, T.W. (2005). Personal construct theory, phenomenology and pragmatism. History and Philosophy of Psychology, 7, 23–35. Butt, T.W. (2008). George Kelly. Basingstoke: Palgrave Macmillan Cromwell, R.L. (2011). Being human: Human being. New York: iUniverse. Dewey, J. (1982). The development of
American pragmatism. In H. Thayer (ed) Pragmatism: the classic writings. (pp.23–40). Indianapolis: Hackett. (Original work published 1931) Holland, R. (1977). Self in social context. London: Macmillan. Kelly, G.A. (1955). The psychology of personal constructs. New York: Norton. Kelly, G.A. (1969). Sin and psychotherapy. In B. Maher (Ed.) Clinical psychology and personality: The selected papers of
of his essays, articles and talks were drawn together after his death and published by one of his ex-students, Professor Brendan Maher (1969). In these collected papers, Kelly moved to correct the growing misapprehension that construing was synonymous with thinking, and therefore the cause of behaviour. There is an emphasis on construing as action, and not in some strange way behind it. Personal constructs are not yet another way of constituting the ghost in the machine. Although Kelly always insisted that a construct was not a concept, his 1955 definition focused on things: ‘A way in which some things are construed as being alike and yet different from others’ (1955, p.105). This allows (and perhaps even encourages) the reader to think in terms of concepts. The construct is an abstraction that differentiates between ‘things’. In what we may call the ‘later Kelly’ however, the two poles of a construct are not things, but possible courses of action. I might dig the garden or read a book. This bipolarity represents a choice that has to be made from my point of view. The alternatives are not logical opposites of course, but represent the alternative courses of action I see open to me at a particular time. Each course of action carries its own implications, and it is anticipation of these that guides my choice. Now the gnomic fundamental postulate becomes clearer: how I think, feel and act (my processes) is channelled by this anticipation. Of course agency and choice carry with them responsibility. We are necessarily in a moral field. None of us can foretell the future. We try to anticipate it, sometimes with a great deal of reflection, but we can never know all the consequences of any action. We can do our best, but frequently make mistakes. Anxiety and guilt are inevitably bound into the human condition. Nowhere is this mixture of action, choice and ethics more evident than in
George Kelly (pp.165–188). New York: Wiley. (Original work published 1962) Kelly, G.A. (1969) Psychotherapy and the nature of man. In B. Maher (Ed.) Clinical psychology and personality (pp.207–215). London: Wiley. (Original work published 1963) Maher, B. (Ed.) (1969). Clinical psychology and personality: The selected papers of George Kelly. London: Wiley. McWilliams, S.A. (2009). William James’
pragmatism and personal construct psychology. Personal Construct Theory and Practice, 6, 109–118. Sartre, J-P. (1995). Humanism and existentialism. In W. Baskin (Ed.) Essays in existentialism (pp.31–62). NY: Citadel Press. (Original work 1965) Warren, B. (2010). Kelly’s personal construct psychology and Dewey’s pragmatism. Personal Construct Theory and Practice, 7, 32–40.
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‘Sin and psychotherapy’, a paper Kelly first delivered in 1962 at Temple University. Kelly begins by relating how a psychotherapy patient likened a particular experience of shame to being expelled from the Garden of Eden. One interesting feature of Kelly’s later papers is the recurring theme of the Garden of Eden. It is central in two: ‘Sin and psychotherapy’ (1962/1969) and ‘Psychotherapy and the nature of man’ (1963/1969), and is mentioned in passing in at least three others. It is probable that the Eden myth represents a folk memory of huntergatherer societies, wistfully recalled by the Jews after the sacking of Jerusalem around 600BC. ‘Civilisation’, with its settled farming communities, brought with it some advantages and also the disadvantages of established hierarchies, conflict and wars. The interpretation of the myth has taken various forms, and the story of its being about original sin is a relatively recent Christian variant (see Armstrong, 2006). It is this aspect of it that interested Kelly. Adam and Eve are given the opportunity by God to lead a life of obedience and passivity in the Garden. The only thing they are forbidden to do is eat from the Tree of Knowledge. This of course they do, as a result of which they understand the difference between good and evil. They are then expelled for ever from the Garden. We, their descendents carry this burden of sin; we lead lives of misery in this vale of tears. No matter how hard we might try, there can be no return to the idyllic existence of passivity and blind obedience. Kelly proposes a personal construct analysis of the myth in which personal constructs are focused on action and choice, not mere cognition. There are three choices: companionship versus loneliness, knowledge versus obedience, and good versus evil. The author of Genesis, Kelly says, recognised these as central to the human condition; each of us is confronted with such choices. We might try to evade them, in what he sees as abortive attempts to return to the Garden. And the ultimate choice is between good and evil. Faced with this, we might imagine that we can do nothing, but of course doing nothing is itself a choice. So, for example, the person who does not intervene to expose cruelty or corruption is indeed making a choice, doing something, no matter how much they might tell themselves otherwise. Looking the other way is indeed a moral choice. Echoing the work of Mowrer and Szasz (although he mentions neither), Kelly
argues that psychiatry tries to redefine sin elaborating what Jesus said about sin: ‘Go in medical terms. Indeed scientists and and sin no more’. Repentance (as opposed philosophers also try to avoid the to atonement) means resolving to act good/evil issue, but it is in the end differently in the future. inescapable. The focus on inevitable choice, One of Kelly’s students, Professor Rue anxiety and guilt in the human condition L. Cromwell, maintained an extended raises the question first asked by Holland correspondence with Kelly from 1952 (1977) of whether Kelly should be until Kelly’s death in 1967. This has been considered an existentialist. Certainly an invaluable resource to me in research Kelly’s catalogue of strategies for avoiding in this area. After reading ‘Sin and the choice between good and evil echoes psychotherapy’ he wrote registering Sartre’s (1965/1995) notion of ‘bad faith’. surprise that Kelly appeared to have And there are clear similarities in the abandoned what in 1955 he called his foundational tenets of personal construct ‘philosophical position’: constructive theory and existentialism. In each there is alternativism. This stated that any events no essence to individuals, no internal in the world were open to alternative gyroscope or inner self that silently construction. But it now guides them – people appeared that good versus do not ‘discover evil was a choice that themselves’, but are “the evasion of personal wasn’t open to self-inventing. Both responsibility can never reconstruction. see people as agents Kelly replied that we that choose between be so simple” should constantly revise courses of action, and how we construe good or not driven by internal or evil (which of course we external forces. do), but that the construct itself is But as we have already noted, Kelly’s indispensable. So Cromwell was surely theory is firmly rooted in American right; Kelly believed that the construct pragmatism. There are parallels in the of good versus evil transcended human development pragmatism the USA and construction and ultimately could not be the philosophy of existence in continental avoided. In the article he lists common Europe (see Butt, 2008). But there are strategies for avoiding the choice – also differences in both content and tone. obedience to a superior authority and rule So, for example, pragmatism is more following, for example. But the evasion of optimistic in its belief in human progress; personal responsibility can never be so Dewey made the scientist something of a simple. Being human means that each moral hero, emphasising the importance of us makes active choices, without ever of experimental venture. To claim that knowing all the consequences of them. pragmatism is really a form of Sin is a constant risk, and anxiety and existentialism is like claiming that a lion guilt are inevitably woven into the human is really a tiger. There are evident condition. structural similarities, but the differences Perhaps Kelly’s main message in the reflect their evolution in separate cultural paper is that we cannot define sin by climates. referring to any sacred text or indeed any I think the main reason why PCT other authority. Sin is defined personally is marginalised today is that it is seen and is to be understood in terms of as such an oddball theory. It is cast in deviation from one’s core role. For Kelly, a vocabulary strange to contemporary ‘role’ referred to any personal psychology. As Kelly warns the reader in construction undertaken in the light of his preface to The Psychology of Personal what we see as others’ perception of us. Constructs, there are none of the Core role concerns how we evaluate landmarks familiar to the psychologist ourselves in the light of the perception of in it: no emotions, cognitions, learning, others that are central to us. In the article motivation, reinforcement or unconscious he asks the reader to compare how they (1955 p.x). Perhaps it will be appreciated would feel differently if they had an better if contemporary psychologists accident, and if a child in their care had recognised it as pragmatism. Dewey had one. The second is likely to produce guilt focused, among other things, on if one feels they have fallen short of the education, and Mead on social child’s expectation of care and protection. psychology. Kelly’s contribution was to This individualised definition of sin and elaborate pragmatism as an approach to guilt perhaps reflects Kelly’s roots in personality and clinical psychology. Protestantism. His father was a I Trevor Butt is Emeritus Reader in Presbyterian minister and he attended Psychology at the University of Huddersfield a Quaker college in his youth. Indeed he t.butt@hud.ac.uk ends the paper saying that he is merely
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