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Tuesday, 13 February 2018


Following on from having been shown warm hospitailty we had a very interesting discussion in Madrid recently with Spanish 'Psychologists in Education' colleagues.This term has now evolved as the preferred term to describe the professions role ascribed by the Standing Committee for Psychology in Education for EFPA (The European Federation of Psychological Associations) on which I am a representative for the Division of Educational and Child Psychology (BPS). I will attempt use a simple framework to promote discussion of of some key constructs in a complex map of variables which may be helpful to shed light on what our role should be in the twenty first century. The term 'Recentering' is used as an appropriate metaphor based on the search engine button on their mapping sites.
In my view as a psychologist coming to the end of his enjoyable and emotionally challenging career there are still some 'elephants in the room' which need putting to bed once and for all to allow us to move on collectively and make a positive contribution to the communities we serve at a school, locality and national level. One that I will come back to later is the questionable practice of IQ assessment described by one Principal EP in the West Midlands as,
IQ testing is an anachronistic encapsulation of the entrenched 'medical model' thinking within the EP profession.It clearly perpetuates an exclusive philosophy at the heart of educational assessment, which can only have detrimental effects on the outcome of the assessment as it is far from comprehensive in nature. What we need are creative, optimistic and holistic means of documenting an individual's strengths and potentials, which measures rates of progress and gives hope for the future to an individual and their family.
This was taken from my chapter, "How Educational Psychologists help to promote inclusion and acceptance of diversity within local schools in the U.K. using a framework of community psychology." Trentham Books 2017 for University College London, Institute of Education Press. Indeed this book consists of 13 case studies of the different European countries who contributed under EFPA's banner to promote further discussion of this topic. IQ tests can not be justified within an Inclusive context based on Humanistic and/or Community Psychology principles. Indeed I recently questioned why we should administer one to an adult for a Social Care colleague as the adult had identified Asperger's Syndrome whose core feature is how people with this difference cope or not, as the case may be, with mental distress and I was being asked inappropriately to do an assessment that would automatically make the client more anxious/distressed. It is a logical non sequitur by anyone's definition.
We no longer need to justify our existence by following 'Medical Model' approaches to labelling abnormality and need to Normalise descriptions of Difference.
To provoke debate further on some wider issues arising from our productive meeting, I will start with an idea I mooted in the meeting mentioned above in Madrid, which is an extension of a provocative maxim used recently by the eminent child and adolescent psychiatrist Professor Sami Timimi which is 'Drop the D for Disorders' by which he means we need to remove the sometimes unhelpful diagnostic labels tagged onto our young people and replace them with socially constructed descriptors of needs which we can respond to in a personalised and creative solution focused way. so a better way of describing a child with ADHD is to say that they have needs in the areas of attention and concentration in class and respond in an agitated way when distressed possibly. A young person with ASD is on the Austistic Spectrum of needs and has differences some of which may cause real difficulties to them in school and some of which can be beneficial like strong visual memory and intense interest/creativity in certain topics. Such a child with this pattern is unlikely to need a strong anti-psychotic drug like Risperdal to 'take the edge off their anxiety,' which is the rationale given often to parents, by medics, especially when long term use can cause the potential 'criminal injury' of lactating breast development in boys which have to be surgically removed. This was proven by the legal case taken by the U.S. Department of Justice against the manufacturer in 2013 where the settlement was a startling $2.2 billion. See the New York Times article.
So to expand this idea to three areas of our shared 'Map' and 'Journey' together that I suggested to them were in fact three D's which we should try not to use thus giving ourselves a new 'Compass' for our vital work in the twenty first century, to ensure that we are 'ethically mindful' and empowered to 'make a difference' at at school, local community and national policy making levels.
Drop the D - Diagnosis
As professionals wedded to the principles of Humanistic and Community Psychology, as many of the profession are, we must, I believe, move to the position of using socially constructed ideas of Psychological Formulations in our work rather than the 'Medical Model' notions of supposed diagnostic integrity. One of the key pioneers in this field is Dr Lucy Johnstone and all who have heard her expound her thinking at conferences and training sessions over the last decade can not fail to be impressed with the clear vision of her model.

She better than I outlines the contours of the preferred features in the map of understanding the mental distress of young people by using a social understanding of their often traumatic experience in early life and how that impacts on their current difficulties and their future hopes. A few of her slides start to illustrate the meaning of the term.

Drop the D - Disorder
As mentioned earlier the illustrious academic, author, friend and colleague Sami Timimi came up with this maxim which in my view and those of participants in his excellent workshops radically redraws the map of our professional work in the future and points us to a new direction via a 'Social Model' for the world of mental health in children and young people.

We can learn from a long lasting debate in the field of disability as to the problems with over reliance on a 'Medical Model' explanation as applied to the Mental Health and Wellbeing of young people. Basically is it an expert driven explanation of 'illness' or a collaborative social understanding of complex social and environmental interacting factors that impact on the child's world map.

Below is Courtesy of Disability Nottinghamshire -
Social model of disability
The social model of disability says that disability is caused by the way society is organised, rather than by a person’s impairment or difference. It looks at ways of removing barriers that restrict life choices for disabled people. When barriers are removed, disabled people can be independent and equal in society, with choice and control over their own lives.
Disabled people developed the social model of disability because the traditional medical model did not explain their personal experience of disability or help to develop more inclusive ways of living.
(An impairment is defined as the limitation of a person’s physical, mental or sensory function on a long-term basis.)
Changing attitudes to disabled people
Barriers are not just physical. Attitudes found in society, based on prejudice or stereotype (also called disablism), also disable people from having equal opportunities to be part of society.
Medical model of disability
The social model of disability says that disability is caused by the way society is organised. The medical model of disability says people are disabled by their impairments or differences.
Under the medical model, these impairments or differences should be ‘fixed’ or changed by medical and other treatments, even when the impairment or difference does not cause pain or illness.
The medical model looks at what is ‘wrong’ with the person and not what the person needs. It creates low expectations and leads to people losing independence, choice and control in their own lives.

Medical Model vs. Psychosocial/Behavioral Model

August 1, 2013 By Phil Hickey Courtesy of Behaviorism and Mental Health
An alternative perspective on psychiatry's so-called mental disorders
Obviously there are many points of contention between mainstream biological psychiatrists on the one hand, and those of us who condemn this system as spurious and destructive. Much of what I’ve written on this website over the past four years has been an elucidation of these differences.
Today I would like to focus on just one of these differences:  disempowerment of clients in the psychiatric system, and empowerment within frameworks that are more psychosocial/behavioral in nature.
Within a psychosocial/behavioral system, if a person is routinely doing something that is counter-productive, or harmful, or sub-optimal in some manner, the working hypothesis is: either that the person has acquired the habit of operating in this way in these circumstances, or has not acquired the habit of operating in a more functional/productive manner, or both. It is also assumed that the habit acquisition has occurred in accordance with the normal principles of learning.
A bio-psychiatrist, on the other hand, assumes that the individual has an illness – a brain malfunction – which causes the problem behavior.
Obviously these two approaches are radically different – indeed, I would say incompatible. But what I’d like to focus on in this post are the implications of the two perspectives.
The implications of the psychiatrist’s perspective are:
1. The individual cannot, from his own resources, do anything to ameliorate his “illness.”
2. To effect any change in his behavior, he must take the psychiatric drugs which the psychiatrist prescribes.
The implications of the psychosocial/behavioral perspective are:
1. The individual is the only person who can effect the behavioral change, though he might need some help, either from natural helpers (family, friends, colleagues, etc.) or professional helpers (counselors, social workers, psychologists, etc.).
2. In those cases where professional assistance seems needed, the blueprint for effective assistance is:
a) to help the individual understand the factors/circumstances that brought about the problem in the first place. This might include: a history of trauma; an impoverished learning environment during formative years, absence of effective coaches/teachers, etc.;
b) to help the individual identify and define the problem in specific terms; perhaps dismantle the problem into component parts;
c) to encourage a sense of competence and empowerment;
d) to develop, with the individual, specific plans for replacing sub-optimal habits with habits that are more productive.
The psychiatric perspective, besides being based on the spurious illness premise, breeds a sense of failure and disempowerment. In addition, the damage caused by the drugs militates against the development of the competencies that are needed to address and solve problems. This tragedy is compounded by the fact that the individuals in question are often beset, to begin with, by a profound sense of incompetence/helplessness. They tend to be people who do not have a great track record at tackling problems and overcoming obstacles. 
So a normal reaction of mental distress to an abnormal situation such as witnessing domestic violence is not an illness but a possibly healthy response to a traumatising environmental trigger. We must therefore find creative and supportive ways of dealing with the young person's emotional and mental health needs. Dave Traxson 12-02-18

Drop the D - Drugging Children with Psycho-active Pharmaceuticals.
Obviously this is my area of obsessive interest as some colleagues would quite rightly say but the good news is our Professional Bodies the BPS and the AEP are now more or less united over their concerns about the potential for toxic harm on the young child's developing brain of introducing a possibly 'toxic soup' of biochemicals when we do not fully understand their long term impact on young people.
The British Psychological Society in their excellent submission recently to the NICE Consultation on ADHD made their concerns crystal clear for example on the medicating children under the age of 6 years old issue where they stated in October 2017:
 We would urge that consideration be given to forbidding the prescribing of stimulant-medication to children under the age of 6 years unless there is significant distress caused to the child by their own presenting behaviours, and that medication is supported by a second opinion from parent(s) and a tertiary service. We believe that psychological and psycho-educational programmes are advantageous to children of this age and that psychotropic medications are unnecessarily risky, unethical and of limited efficacy. This is therefore a safeguarding issue. In other European countries such as France medication is not recommended under the age of 7 years.
A ban on such medications for very young children would better Safeguard them from harm which is 'the paramount responsibility of all professionals.'

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