Health Psychology in Clinical Practice

Mark Forshaw, Mark J. Forshaw

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000473889
• Edition: 1
• Topic: Psychology
• Subtopic: Applied Psychology
• Index: Psychology

Health Psychology in Clinical Practice provides a collection of first-hand accounts from several of the most established and experienced clinically working Health Psychologists in the UK, explaining what they do, how they do it and why their work is important.

In recent years, health psychologists have come into their own in being able to provide high-quality, evidence-based, clinical support for patients by utilising relevant therapies. Trainees and would-be clinical practitioners in the health psychology community are keen to learn more about this aspect of their craft, and this book provides a valuable source of information they can turn to – unlike the vast majority of literature on clinical practice in psychology, written by clinical psychologists, which is mostly of tangential relevance to a health psychologist. As a compilation, the first-hand accounts within Health Psychology in Clinical Practice provide a guide that will help define what clinical health psychology is and should be for a decade or more.

This book is an essential resource as a crucial snapshot of practice in the discipline in the UK and will additionally support trainees and those seeking a career in health psychology centered on practice rather than research or teaching.

1 Supporting people to live with and manage long-term physical health conditions

Kate Hamilton-West

DOI: 10.4324/9781003120469-2

This chapter provides a personal account of my experience as a Health Psychologist specialising in improving care and support for people with long-term physical health conditions (LTCs). I begin by considering how direct patient care fits with other aspects of my work, before going on to describe the approach I have taken to supporting patients with LTCs. I then reflect on some of the opportunities and challenges for Health Psychologists involved in direct patient care and suggest some future directions for Health Psychology practice.

How direct patient care fits with other aspects of my work as a Health Psychologist

Health Psychology is the aggregate of the specific educational, scientific, and professional contributions of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of etiologic and diagnostic correlates of health, illness, and related dysfunction and to the analysis and improvement of the health care system and health policy formation.

(Matarazzo, 1982, p. 4)

As a professor of Health Psychology and HCPC (Health and Care Professions Council) registered Health Psychologist, my work has encompassed research, teaching and supervisory roles, along with service development, delivery and leadership, consultancy, and direct patient care. This has included for example, directing MSc programmes in Health Psychology and applied health research, supervising and examining PhD and professional doctorate students, developing and delivering training for health professionals supporting people with LTCs (e.g. Hamilton-West et al., 2018), developing behavioural science informed curricula for medical students (Hamilton-West, 2018b), developing and evaluating interventions to support self-management of diabetes (e.g. Hamilton-West et al., 2013) and enhancing self-efficacy in carers of children with disabilities (e.g. Hotham et al., 2017), developing and leading an NHS diabetes psychology service (Hamilton-West et al., 2014), working directly with people living with comorbid mental and physical health conditions (Hamilton-West, 2016), establishing and leading a regional Health Psychology network, acting as practitioner chair for the BPS Division of Health Psychology and as health psychology lead and Kent academic lead for the NIHR Research Design Service South East (part of the National Institute for Health Research).

These roles are very much interconnected. For example, knowledge of Health Psychology research and theory (maintained via research and teaching roles) feeds in to the development of services and interventions (delivered at one-to-one or group level), while knowledge of ‘what works in practice’ (developed via direct patient care and service development/ leadership) is fed back to refine theory and extend the evidence-base (e.g. via publications, conference presentations and training workshops). These interrelationships are illustrated in Figure 1.1 (below).

Figure 1.1 Interrelationships between Health Psychology roles

The outer circle (above) illustrates some of the factors that shape our work as Health Psychologists. For example, working as a Health Psychologist necessitates knowledge, skills and competencies relevant to the role (e.g. specific psychological therapies, or research methods), knowledge of adjacent disciplines and roles (e.g. health services research, behavioural and social sciences, other healthcare professions), awareness of relevant regulatory, professional and ethical frameworks (e.g. British Psychological Society, Health and Care Professions Council, NHS Health Research Authority) and understanding of the sector/context (e.g. NHS, Public Health, Higher Education). Ongoing work (e.g. CPD training, supervised practice, active engagement with professional bodies) is needed to ensure that these remain up to date.

While knowledge, skills and competencies represent what we need to know to work as Health Psychologists, personal values and goals explain why we do this work. For example, personal values might include a commitment to scientific integrity, or equality, diversity and inclusivity, while goals might include advancing disciplinary knowledge, or improving quality of life for people living with LTCs. Personal values and goals provide direction and meaning. It is possible to work towards these in various ways. For example, improving quality of life for people with LTCs may be achieved via direct patient care, by development of interventions and services, by training and supervising health professionals, or by conducting research that advances the underlying evidence-base. As such, the roles illustrated in Figure 1.1 can also be considered as pathways for translating Health Psychology research and methods into real world impact.

Beyond this circle are factors relating to the local, regional, national and global context. These include for example, global health challenges, government policy pertaining to health and social care, regional healthcare priorities and local health and wellbeing initiatives. These factors shape our work as Health Psychologists in various ways, such as by influencing the focus or availability of funding, raising awareness of issues relevant to our work (such as high levels of unmet psychological needs in people with LTCs), or providing opportunities to develop and implement interventions and services. We can also influence these agendas – for example, by disseminating research findings and examples of evidence-based practice, contributing to national consultations, working with local authority public health teams, or NHS clinical commissioning groups, or serving on relevant committees and advisory groups (e.g. for research funders, professional membership bodies, NHS Trusts, or national Government). Essentially, all of these examples involve sharing our expertise as Health Psychologists with relevant partners and stakeholders. To do so effectively, we need to build relationships beyond our own profession, identify opportunities to apply our knowledge and skills, communicate Health Psychology research and theory clearly (in terms that make sense to a range of specialist and non-specialist audiences) and act as ‘ambassadors’ for our profession – demonstrating the positive contributions Health Psychologists can make and the importance of incorporating Health Psychology perspectives. Working closely with partners and stakeholders also enables us to learn from others (e.g. patients, service users, carers, clinicians, service providers, commissioners and policy makers), ensuring that the work we do has ‘real world’ relevance and impact.

Supporting people living with long-term conditions

Psychologists who provide healthcare services engage in evidence-based practice that is patient-centered, culturally competent, effective, and informed by population-based data. They are skilled in collaboration with other health professionals and demonstrate a commitment to lifelong learning and continuous quality improvement in their practice. They are grounded in psychological science and integrate knowledge from other areas such as biology and sociology into their practices as appropriate. They are not only critical consumers of psychological research, but able to conduct scientific research, especially practice-based outcomes research and program evaluation.

(HSPEC, 2013, p. 1)

Working clinically as a Health Psychologist involves adopting approaches which are evidence-based and appropriately tailored to the individual and context, drawing on relevant research and theory. My own clinical work has mainly focused on supporting people living with LTCs, often in the context of reduced psychological wellbeing, including diagnosable mental health conditions. I draw from a wide evidence-base including epidemiological studies examining prevalence of psychological co-morbidities in people with LTCs (e.g. Katon, 2011), ethnographic research on patient experience of self-management (e.g. Hinder & Greenhalgh, 2012), research on predictors of ‘adherence’ (e.g. Delamater, 2006) and studies examining the effectiveness of psychological interventions for people with LTCs (e.g. Anderson & Ozakinci, 2018), as well as NICE guidance and reports by charities and government bodies (e.g. The Kings Fund, The Health Foundation, NHS England).

Figure 1.2 Questions to consider for developing a career in health psychology

Theoretical frameworks I have found particularly useful in this context are the Common-Sense Model of Illness Representations (CSM; Leventhal et al., 1992) and Social Cognitive Theory (SCT; Bandura 1977). The former helps to explain how individuals make sense of and cope with their condition, while the latter explains how to help people develop confidence in their ability to carry out behaviours necessary for self-management (e.g. making changes to diet, physical activity, monitoring symptoms, or taking medicines). These models are can be used to guide direct patient care, to design interventions for people with LTCs and to train other health professionals to deliver patient-centred care (see Figure 1.3).

In terms of therapeutic approaches, I have found acceptance and commitment therapy (ACT) particularly helpful for supporting people to manage the wide-ranging impacts of chronic illness. ACT incorporates training in mindfulness and acceptance strategies (to improve management of negative thoughts, feelings and physical sensations, including illness symptoms and pain) and a focus on working towards goals and values in the face of difficulties (e.g. Brassington et al., 2016). This is important for people with LTCs since health problems often place constraints on daily living and interfere with valued goals. In addition, cognitive behavioural interventions (drawn from cognitive behavioural therapy; CBT) and motivational interventions (drawn from motivational interviewing; MI) can be used to support self-management by helping people to develop routines that are realistic and work for ...

Table of contents

• Cover
• Half Title
• Endorsements
• Title Page
• Copyright Page
• Table of Contents
• List of illustrations
• Acknowledgements
• List of contributors
• Introduction
• 1. Supporting people to live with and manage long-term physical health conditions
• 2. Health Psychology in an NHS pain management service
• 3. The twists and turns into Health Psychology
• 4. Delivering an NHS Health Psychology service for patients with eye cancer
• 5. A spectrum of applied Health Psychology: Across public health and healthcare practice
• 6. Beating your imposter syndrome to become a practitioner Health Psychologist
• 7. Health Psychology in a clinical setting: How it works for me
• 8. Assessment in Health Psychology clinical practice
• 9. Formulation in Health Psychology clinical practice
• Afterword
• Index