A Social Construction of Identities in Clinical Psychology Training in the Uk: A Focus Group Study

doi:10.21203/rs.3.rs-5123678/v1

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Research Article

A Social Construction of Identities in Clinical Psychology Training in the Uk: A Focus Group Study

https://doi.org/10.21203/rs.3.rs-5123678/v1

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Purpose The training of clinical psychologists is conducted by clinicians, academics, trainees, service users and carers. Often those working in clinical psychology do so due to their own lived experiences. These stakeholders may require navigating both personal and professional identities in their roles. This study aimed to understand identities within UK clinical psychology training.

MethodFocus groups were used to socially construct and measure identity constructions of groups in clinical psychology training. A social constructionist lens was used to thematically analyse data.

FindingsFour themes were found across groups. Theme 1 identified ‘dynamics of identity’ where personal and professional identities were ‘integrated,’ ‘separated,’ ‘permeable,’ or ‘visible/invisible.’ Theme 2 found the ‘impact of language and labels to rebalance power’, encompassing, ‘expectations and invalidation of a label,’ ‘weight of a label,’ and motivations to ‘rebalance the power.’ Theme 3 constructed ‘learner’ and ‘expert’ identities for each group and Theme 4 found ‘Bridging Them & Us divisions’ by identifying, ‘Feeling Similar and Different,’ and ‘Barriers and Connections.’

Implications and Conclusions This is the first study to use focus groups to socially construct and measure identities in clinical psychology training. The research gives clarity to identities within clinical psychology training and can help bridge Them & Us divisions, promoting effective collaboration across the workforce.

Clinical Psychology

Service user involvement

Lived experience

Personal Identity

Professional Identity

Key contributors to UK Clinical Psychology training are clinical and academic psychologists. They have the relevant qualifications and training to perform these roles and are referred to in this article as Experts by Qualification (EBQ). Other equally important contributors are service users and carers who have experience of disability and of psychological services, or of supporting a loved one with these experiences, who are referred to as Experts by Experience (EBE). Both EBQ and EBE trainers select, teach, and evaluate UK trainee clinical psychologists’ clinical and research skills. These trainers have the purpose of enhancing trainees’ learning which is perceived to be beneficial by trainees, staff and service users(Sheldon & Harding, 2010). Policy changes(Department of Health, 2000), and shifts towards consumer-led movements(Chambers & Hickey, 2012) has led to mandatory EBE involvement in clinical psychology training. EBE involvement supports the trainees’ understanding of the service user and carer perspective of disability and of NHS psychological services. EBE involvement leads to benefits for trainee clinical psychologists and is shown to enable them to become more person-centred (BPS, 2010), positively enhances their learning and clinical skills (Schreur et al., 2015) their communication and empathy (Repper & Breeze, 2007), and their ability to apply more critical approaches to work (Harper et al., 2003). In addition to enhancing trainee clinical psychologists’ skills, EBEs performing these roles also personally benefit, impacting wellbeing, recovery and identity (Hill, 2021).

The theoretical basis of identity suggests the groups in which individuals belong lead them to feel similar with their in-group and different towards out-groups (Tajfel & Turner, 1979). Roles that individuals occupy and perform in a structured society are formative to identity (Stryker, 1980). Identities are reinforced through interactions, promoting behaviours to operate consistently with the meanings attached to these social identities, such as the EBE, trainee, carer or EBQ.

Tse et al., (2012) suggest that service user involvement may lead to changes in social identity. The EBE role encourages professional and politicised identities, moving EBEs away from their stigmatised patient roles (Toikko, 2016). Additionally, changes in identity affect carers due to losing who they were prior to becoming a carer and their new relationship with their loved ones (Andrasson et al., 2017). Similarly, changes in identity affect mental health professionals who must navigate personal and professional identities which are sometimes integrated or unintegrated (Richards et al., 2016). Fox, (2016) describes navigating these identities as a ‘balancing act, requiring negotiation.’ Additionally, trainee clinical psychologists are described as learner and practitioner (Woodward, 2014) and clinical psychologists as practitioner and researcher (Garfield, 1966).

A systematic narrative review (Gupta et al, 2023) found that the identities of lived experience researchers and providers, including EBEs and EBQs, consisted of professional and service user identities that were sometimes integrated, unintegrated and liminal. These positions of identity were affected by themes found in the EMERGES framework: empowerment, motivation to integrate, empathy of the self and others, recovery model and medical model, growth and transformation, exclusion, and survivor roots, giving a means from which to begin to understand the identities found within clinical psychology training. The review found studies included had methodological flaws and bias. There was a paucity of research on carers and only one study was from clinical psychology. This provided a rationale for this study, with the aims to understand the common and unique identities in clinical psychology training, of EBEs, carers, trainee psychologists and EBQs and to use this knowledge to support greater collaboration in this context.

The study aims were to understand identities within UK clinical psychology training, of EBEs (service users and carers), trainee clinical psychologists and EBQs through focus group methodology.

Design

Four separate focus groups of EBEs (service users), carers, EBQs (Clinical/Academic Psychologists) and trainee clinical psychologists explored their social identities. These groups were mutually exclusive based on how the participants self-defined their occupational roles in UK clinical psychology training. Focus groups lasted approximately 90 minutes.

Inclusion criteria

Participants had to self-define as EBEs, carers, Trainee Clinical Psychologists or EBQs (academic or clinical psychologists) working within UK clinical psychology training. They were not limited by gender, ethnicity, sexuality, or disability and had to be at least 18 years. It was acknowledged that some individuals may span multiple roles, such as a trainee being an EBE and a clinical psychologist being a carer but the eligibility for joining a focus group was based on their occupational role within clinical psychology training. Where there were dual identities such as an EBE also being a carer they were given the choice of which focus group to participate in based on their most salient identity.

Recruitment

Recruitment advertisements were circulated on Twitter and sent to all UK Doctorate Clinical Psychology programme directors, course specific contacts, and to the British Psychological Society’s Group of Trainers in Clinical Psychology (GTiCP).

Participants

Twenty-five participants from nine Doctorate in Clinical Psychology programmes in England took part across four focus groups. Of the 25, eight were trainee clinical psychologists, six EBEs, seven carers and four EBQs (two Clinical Psychologists and two Academic Psychologists). See Table 1.1 for their demographics.

Table 1

Sample Characteristics
Focus group	Sample: N = 25	Gender 16 Female 9 Male	Age 28–75 years	Ethnicity	Context
Trainee Psychologist	N = 8	7 Female 1 Male	28–36 years	White, White Other, Mixed race (White and Caribbean)	In person
Expert by Experience	N = 6	2 Female 4 Male	35–65 years 1 participant did not disclose	White, British Cypriot	Online
Expert Carer	N = 7	5 Female 2 Male	56–75 years	White and White other	Online
Expert by Qualification	N = 4	2 Female 2 Male	37–62 years	White, Latinx/Hispanic	Online

Ethics

Ethical approval

was granted by university ethics committee (REF ID 5417). Participation was dependent on who responded to advertisements, met eligibility and who provided informed consent after having read and understood the information sheet. Participants were debriefed at the end of each focus group. The data provided were kept confidential and identities pseudo-anonymised. Participants could withdraw their data up to the point of anonymisation. Participants were offered a £20 voucher and travel expenses. Two participants asked for partial data removal.

Positionality

This research was led and developed by VG an EBE and PhD researcher, based on her own experiences of positive changes in identity through EBE involvement in UK Clinical Psychology training. A reflexive approach to supervision was used and themes generated with the research team, including academic research psychologists, CE, clinical psychologists, PF, LG, BG, and EBE, AB. VG kept a reflective diary throughout and was mindful to understand and value experiences that both coalesced but also differed to her own perspectives. VG continued to be an EBE in clinical psychology training whilst conducting this research.

Focus groups

Focus groups were used to investigate the research question. Touraine, (1981) believed that working with strangers in a focus group would mirror the wider social movement they belong to. The focus groups were either held in person at university, or via Zoom conferencing services, due to COVID-19 restrictions with no hybrid option. The discussions were audio-recorded, transcribed, and analysed using NVIVO. VG was the interviewer and followed a semi-structured interview schedule with prompts to guide the discussion. The interview schedule was created and tested with key stakeholders including EBEs, carers, Trainee Clinical Psychologists and EBQs. The researcher established mutual expectations and a confidential space. The discussion started off broad with an exercise to reflect on identities, prior to exploring the research aims.

Analysis

A social constructionist approach with critical realist ontology was taken. A thematic analysis was used, which is not bound by epistemology and can be used for multiple datasets (Braun & Clarke, 2006). The stages of the thematic analysis were followed: 1. the researcher familiarised herself with the data by reading transcripts and listening to recordings, 2. coding meaningful segments of the data in an inductive way, 3. generating initial themes, 4. reviewing themes, 5. labelling themes, and then 6. defining themes as a research team iteratively (Braun & Clarke, 2006).

Four overarching themes were common across the focus groups. The first theme was dynamics of identity that found identities could be split into personal and professional identities that were ‘integrated’, ‘separated’, ‘permeable’ and ‘visible or invisible’. The second theme was the impact of language and labels used to describe these groups led to ‘expectations and invalidation of a label’. The burden of these labels is described by ‘weight of the label’ with motivations to use language to help ‘rebalance the power’. The third theme found ‘learner and expert’ identities regarding their ability to perform their roles and engage in lived experience work. The fourth theme was ‘Them & Us divisions’ that were bridged through ‘Feeling similar and different,’ by understanding ‘Barriers and Connections’. A summary is provided in Table 1.2.

Table 1.2

Overarching and subordinate themes
	themes	Sub-Themes	Trainee	EBE	Carer	EBQ
1.	Dynamics of Identity.	Separation	x		x	x
		Integration	x	x	x	x
		Permeable	x	x	x	x
		Invisible/Visible	x	x	x	x
2.	The impact of language and labels to rebalance power	Expectations and Invalidation of a Label	x	x	x	x
		Weight of a label	x	x	x	x
		Rebalance the power	x	x	x
3.	Learner and Expert.	Learner	x	x		x
3.	Learner and Expert.	Expert		x	x	x
4.	Them & Us Divisions	Feeling similar and different	x	x	x	x
4.	Them & Us Divisions	Barriers and Connections	x	x	x	x

Theme 1: Dynamics of identity ‘ a strange mix of personal and professional and caring.’

This theme described how personal and professional identities applied to each stakeholder that requires negotiation. These identities sometimes permeated each other, were actively separated, or integrated, depending on motivations to conceal or reveal lived experiences, dependent on perceived stigma.

1.1: Separation ‘ I’m determined for those identities to stay separate.’

This sub-theme described EBQ, carer and trainee participants’ need for separation between their personal and professional roles. This separation reduced the burden of lived experience on the individual.

Trainee, Serena, spoke about separating her role as a trainee clinical psychologist and her personal life. “I understand why reflective practice is really important...when you’re working clinically, but I don’t want to be reflective in my personal life...I want to be reflective in my professional role, when I come home…I’m a sister, daughter, partner… I’m determined for those identities to stay separate...”

EBQ, Sharon, discussed how lived and professional experiences were considered as distinct, and felt forced out of the conversation as a professional with lived experience. “…they are social constructs that tend to be thought of as mutually exclusive. I mean they’re not in reality.... someone was coming to train us about how to do service user involvement and he was making a virtue of… this isn’t about professionals and… I felt like that professional bit of me was being pushed out of the room.”

Anthony highlighted how his carer experience was consumed by healthcare issues and how there was a need to separate from this burden. “…sometimes...everything’s around service provision... rather than getting drip fed what was going on with health and social care..., sometimes carers just need that escapism...”

1.2: Motivations and Conflicts to Integration ‘ I’m almost wanting to bring those two senses of self together,’

Trainee participants wanted to integrate their lived experiences into their roles but did not know how to do this, whereas EBE participants were able to do this confidently.

Trainee Ruth identified how she wanted to integrate both her lived and professional experiences in her role, which was different to her earlier motivations.“…I’m almost wanting to bring those two senses of self together … much earlier on in my route into training…I wanted to push them separately... Whereas now I'm... keen to bring those two things together...and feel like a more coherent…version of me...”

EBE, Zara, spoke of how she sought to integrate models she identifies with into the teaching she does. “I do quite a lot of teaching in…universities… coming from a very much trauma informed (approach)... what you can do is try and embed aspects of that in…, people’s day to day working.”

EBQ, Maria, said that speaking about her own personal experiences helped reduce her expert status and connect her to EBEs. “I felt like because of my expert status they were like… here she comes telling us what to do… I had to really express where I come from more and more... so…they don’t see me as the professional.”

1.3: Permeable ‘ I don’t think you can necessarily untangle the two identities,’

The sub-theme of permeable identities represented the seeping of the professional role into personal life and vice versa. This was described by trainees and EBQ participants similarly. Carer participants articulated that their own personal identities tied them to those they supported.

Trainee, Mary, who is a trainee clinical psychologist and also worked in lived experience roles, described how her lived and professional experiences were inseparable. “… I think it depends on who sees me...I don’t think you can necessarily untangle the two identities.”

In a comparable way, carer, Jane, spoke of how the carer role and the health outcomes of those they support are inextricably linked. “… it’s always the way that if the Carer goes down, the person they care for is always down, so that’s two people in hospital.”

Trainee, Ruth, spoke of the HCPC regulations and how there was an expectation to abide by the professional code of conduct in her personal life. “….in that profession there’s a sense of responsibility... that doesn’t just finish when you finish your day… you are expected to uphold the professional values in your personal life...”

1.4: Invisible/Visible ‘ sometimes our voices are just not heard and sometimes…we’re going to be stepping on…people’s toes…because we need to be heard…the doctors can’t admit to being a service user …’

This sub-theme described the visibility of lived experience within the profession. Trainee participants spoke of a need to share their lived experiences but felt that clinical psychology spaces did not feel safe for this. EBE participants talked about how the purpose of their roles was to increase visibility. In contrast, carers felt they and their needs were invisible.

Trainee, Jess, spoke of how the trainee identity occluded the visibility of lived experience. “I wouldn’t describe myself as an expert by experience but... we had some trauma teaching, and it was quite distressing...there wasn’t anything about looking after yourself in the lecture… the lecturer had almost come in on the assumption... this isn’t going to affect any of you...”

EBE, Denise, identified how the purpose of the EBE role, in contrast to the EBQ role, was to make lived experiences visible. “…sometimes our voices are just not heard and sometimes… we’re going to be stepping on… people’s toes… Because we need to be heard… the professors and the doctors can’t admit to being a service user...”

Carer, Miriam, identified how the carer’s needs were secondary to all, meaning their needs were not recognised by anyone. “… one’s own needs can get so suppressed that they’re not being recognised, even by the individuals themselves.”

Theme 2: The impact of labels to rebalance power ‘ In effect, any label, it’s how it’s used…so you can throw whatever label or term at me …’

This overarching theme described how labels used to describe groups in clinical psychology training reinforced stereotypes, resulting in ‘expectations of the labels’ they were understood through and their behaviour in response to this. The labels had an impact on perceived power dynamics across groups. The participants identified how carefully chosen labels could rebalance the power. There was common consensus that labels were invalidating and burdensome.

2.1: Expectations and invalidation of a label ‘… people often don’t expect...a mixed-race young woman to turn up. ’

This sub-theme captured the different perspectives of trainee clinical psychologists, EBEs and carer participants regarding labels used to describe them. It described how labels reinforced stereotypes held by others and could be invalidating based on perceived meanings associated with them.

Belonging to racial minorities, regional and class identities were discussed across trainee participants. Some felt they did not fit the typical clinical psychologist stereotype.

Trainee, Jess, identified how others did not construct a clinical psychologist to be mixed race and this expectation was invalidating. “...I’ve had service users go, oh is it you that I’m seeing, I didn’t think you’d look like that…, people often don’t expect...a mixed-race young woman to turn up."

Trainee Mary described how in some ways she does and does not fit the stereotypical clinical psychologist, “…it’s sometimes the messages, because I’m really conscious that I’m, white, posh, female....you often hear that you’re the perfectionist, you’re this, you’re the that, which is completely not me at all…”

EBE Phil identified labels and language were chosen for EBEs and could negatively or positively impact those being labelled.

Language and labels have changed over the years…they didn’t care how it affected the individual... In effect any label, it’s how it’s used...so, service user, expert, it doesn’t matter…you can throw whatever label or term at me...

EBEs concurrently agreed that the EBE label was the best option they had but it did not convey the complexity of their expertise. For similar reasons, carers rejected their label, and also ‘informal carer’ and ‘unpaid carer.’

2.2: Weight of a label ‘… the word expert feels a bit pressured...’

This sub-theme described how language and labels used to describe groups in clinical psychology training impacted the carer or EBE, due to the power or burden it exerted.

Carer Joy described the impact the carer label had on her, replacing her identity of being a mother with an impersonal term. “At the beginning being a carer hit me like a ton of bricks…I was a mum and the next thing I have this crisis worker... said I’m the carer. There was no warning... It was like someone had taken my role…as mum, put it in the bin and given me a new title...”

EBQ Simon, observed the effect of the expert label exerting additional pressure. “When I heard the title Experts by Qualification... the word expert feels a bit pressured… I think of Experts by Experience all the time and I’ve never thought that could… put a lot of pressure on someone...”

2.3: Rebalance the power ‘… those structures give you power…so it’s how to rebalance that...’

This sub-theme identified motivations across each group to rebalance power. Trainee participants felt a need to reduce their power, carer participants wanted to increase this and EBE participants wanted to flatten the hierarchy. The sub-theme identified how language and labels could allay power differences.

Trainee, Freya, identified how the label of ‘Doctor’ created a power difference between the patient and the EBQ which could be rebalanced with language. “there’s a bit of a debate… when you get Doctorate…do you come in and say, “I’m Dr so and so,” or…, “Just call me (name)?... coming from that standpoint of, we are all equal… I guess... those structures give you power...So it’s how to rebalance that.”

Carer, Miriam, advocated for a reevaluation of the terms used to describe carers to reduce stigma and increase power. “...we need to come up with a new word. That word carer...it’s so undervalued…It’s got so many negative connotations, like we are propping up members of society, but no one gives us value.”

Theme 3: Learner and Expert ‘ …we’ve all got expert parts and learning parts.’

This theme identified how groups in clinical psychology training were constructed as both learner and expert in juxtaposition. Trainee participants focused on their own inexperienced identities by comparing themselves to EBQs, constructed as experts. EBEs and Carers constructed learner identities of trainee clinical psychologists. All stakeholders were constructed as ‘Learners’ regarding their abilities to engage in effective coproduction.

3.1: Learner

This sub-theme constructed the learner identity of trainee clinical psychologists as individuals uncritical towards lived experience work, or trends in their profession and how they may have taken things at face value without critical thought.

EBE, Michael constructed the trainee as a learner “…...their inability to critique their own professional knowledge, if somethings fashionable within their profession at that time, they can’t step back…. and see why they…might want to challenge... I think particularly for people…early on in their career are really precious of that knowledge...”

Carer, Miriam, thought of the trainee as a learner as they did not feel their reality of their lived experiences was understood by them, when they took things at face value. “Sometimes, they don’t want to hear what you say because it’s not what they would expect...they can’t imagine that somebody is saying… they’re taking medication when they’re not, and I find sometimes… trainees have… resistance to the reality”.

3.2: Expert

This sub-theme described how expert identities were constructed by constructing oppositional groups as learners. The EBQ constructed expert identities of other EBQs as those that listen and learn from others.

Carer, Joy, constructed the expert carer as someone who could spot the needs of other carers new to their role as they had been through the learning process of becoming a carer. “...we could see... perhaps it’s their first time being there… they’re asking questions, but they’re not quite asking the question that they want to ask... We know what it is we’re looking…because we’ve been that person.

Trainee, Serena, viewed her supervisor as an expert by seeing herself as a learner. “...my supervisor...can come up with all of these amazing suggestions...I know about that theory, and… this theory but why did I not connect them in the same way…?

EBQ, David, suggested the expert EBQ was someone who listened and learned, “there’s been a lot of furores…. around ethnicity, race, representation, whiteness, and expertise and saying what… psychological approaches are vs. learning and listening...the generational comment is... important…people coming… on to training... increased communication… access to very different views. These are powerful forces and we’re feeling the effects now. It’s going to be good to be part of that...And not me as an expert guiding it but seeing how those forces shape it...”

Theme 4: Bridging Them & Us Divisions ‘ The bridge between two different types of knowledge.’

This overarching theme identified how EBEs, carers, Trainees and EBQs felt more like their in-group and different to others. Sometimes they also felt different to their own social group, influenced by stances on mental health. Each group felt barriers to other groups and wanted to find ways to connect.

4.1: Feeling Similar and Different. ‘ I feel most connected to people who move beyond an individual experience and turn it into a collective change.’

This theme described how each member of the focus groups felt similar but also different to members in the group, with shared goals and motivations to support their group.

EBE, Zara, said she related to EBEs who wanted to make a difference for the group. “I feel most connected to people who move beyond an individual experience and turn it into a collective change.”

EBE, Michael, connected better with EBEs who understood their mental health experiences similarly to him, “… if someone’s promoting a sort of purely medical perspective, I find that quite difficult to connect with....”

EBQ, Sharon, highlighted her feelings of difference with other EBQs as a research psychologist with lived experience. ‘...at first feeling they’re all pussy footing around me, is it because I’d said to occupational health about my mental health…I thought it’s because I’m a researcher, they’re thinking… she’s going to discover we’re crap at stats....”

4.2: Barriers and Connections ‘ …very difficult…getting in that them and us space…but we’ve got a very good coordinator of service user experience who... pours oil on troubled waters and keeps us all… in line…steering that difficult path between how...we get things changed, but... not alienate everyone in the process.’

This sub-theme described how there were barriers to meaningful lived experience work created by EBQs with motivations to connect groups.

Carer, Louise, noted how EBQs were slow to implement changes from her input. “What worries me is in our involvement...people are still thinking... we could have... trauma informed care for this service... These are not new ideas… yet they’re still not being introduced.”

There was a consistent narrative from trainee participants of their disconnection with EBEs. Trainee, Mary said, “It doesn’t feel like there’s really open communication…it feels very much that it’s led by when they’re on the timetable, that’s when they’re available.”

EBQ Simon, highlighted the structural barriers EBEs experienced. “…we’ve got a limited budget … there’s only so many (projects)…we can fund... they’re never going to feel equal. They’re not on the same payroll, they’re not embedded into the structure on our course...My guess is (they) don’t feel like members of staff...there is an us/them divide still.”

The theme highlighted how to negotiate and bridge connections between groups. Carer Benjamin articulated the power of emotion in enabling this. “If you sort of sprinkle the emotion in there when you’re... talking to them, that actually gets through to them...Better than…just quoting loads of technicalities.”

EBQ, Sharon, suggested that service user involvement required negotiation. “...... It’s very difficult getting in that them and us space…but we’ve got a very good coordinator of service user experience who... pours oil on troubled waters and keeps us all… in line…steering that difficult path between how...we get things changed, but... not alienate everyone in the process.”

This focus group study aimed to understand identities within UK clinical psychology training of EBEs, carers, trainee clinical psychologists and EBQs. Four themes were found. The participants described ‘Dynamics of Identity’ having personal and professional identities that sometimes required ‘Separation’, ‘Integration’ and ‘Permeability’. Lived experiences were either ‘Visible or Invisible,’ with competing narratives across groups regarding its acceptability. ‘Them & Us divisions’ were experienced by all stakeholders. Expert and Learner identities were reported by each group regarding the performance of their roles and ability to engage collaboratively. The labels used to describe these groups resulted in an ‘Expectation and invalidation of a label,’ with some labels being burdensome described in ‘Weight of the label,’ with motivations to ‘Rebalance the power,’ through appropriate language and label use. The themes were based on a social constructionist lens and will be discussed within the context of existing research.

Dynamics of identity

Participants in this study were asked to self-define into their social group in clinical psychology training, and did an identity mapping task, providing sufficient priming to measure their identities. Labelling theory (Becker, 1963) explains how individuals behave in ways consistent with the labels used to describe them. For example, the findings show each stakeholder felt confined by the expectations of their roles when it came to decisions to share lived experiences and having ‘visible’ or ‘invisible’ identities.

Separation/Integration/Permeable

EBE participants in this study wanted to share their personal experiences, despite it being challenging and having an emotional toll, consistent with findings by Faulkner & Thompson, (2021).

In contrast, the separation of personal and professional identities was important to both trainees and EBQ participants, so they did not have to remain accountable to their profession in their personal lives, and for carers to reduce their emotional burden, by setting boundaries. Llewelyn & Gardner, (2009) identify boundaries in clinical psychology helps maintain distance from service users. Despite there being guidance for trainees BPS (2020), guidance for EBEs and carers on disclosures is limited and course specific.

EBEs and carers felt that when they shared their lived experiences led to learning by trainees which is consistent with research by Schreur et al, (2015).

Visible/Invisible

Invisible illnesses become visible when individuals articulate this to others (Pilling, 2012). The EBE participants used their voices to be heard. The labels of EBE and carer personify lived experiences, making them visible. In contrast, trainee clinical psychologists can control whether they share their mental health status. Trainees wanted to be authentic, by sharing invisible identities in public (Clair et al., 2005). Tay et al., (2018) found that EBQs tended to share in their social circles rather than within professional spheres, perpetuating the invisibility of lived experience in the field. Although some mental health professionals with lived experience integrate this into their work (Richards et al, 2016). There may be different expectations regarding sharing of lived experiences across groups.

The study’s findings showed that labels occluded visibility. For example, the needs of carers who were also service users were invisible as they were understood through the lens of loved ones, they supported (Andrasson et al., 2017). Similarly, the EBE is viewed as a service user, meaning their professional expertise is unacknowledged. Conversely, the EBQ is perceived as a professional as opposed to someone with lived experience. These findings are explained by previous research that identified how professional and personal identities were either integrated or unintegrated due to stigma, expectations of roles, and epistemic injustice (Gupta et al, 2023). The BPS (2020) document on valuing lived experience may shift identities in the future.

Learner and Expert

Trainee participants wanted to integrate their lived experiences into their training but felt inexperienced at this. In contrast, EBE participants integrated this effectively, by channeling theoretical frameworks, into their work. This may be an effect of the ‘trainee’ label, resulting in the learner role, and the EBE, reproducing the expert role (Becker, 1963). Alternatively, it may be that EBEs were motivated to introduce knowledge bases into their work because they felt a need to justify their expertise. EBEs constructed learner identities of trainees and themselves as experts, which aligns with the formation of expert identities (Li et al, 2018). Yu & Wu, (2021) identify how novice identities are constructed as needing guidance from experts, mirroring the trainee and EBQ relationship.

Bridging Them & Us divisions

Participants described ‘Them and Us’ divisions between groups. The focus groups may have generated a space in which each social identity was enhanced, exacerbating differences with others (Munday, 2006).

The participants in this study felt that ‘Them and Us’ divisions were not always recognised by those with power, EBQs, but the impact of these dynamics and resistance to involvement were felt by EBEs and carers and Trainee Clinical Psychologists. The findings of this study relate to barriers found in lived experience work (Tambuyzer et al., 2014). Barriers could be permeated and bridged through emotional connections (MacLean & Webber, 2015).

Trainees and EBQ participants spoke of how the profession of clinical psychology was exclusionary through messages on race, gender, class, disability, reinforcing inequalities. There is now guidance on racial and social inequalities in clinical psychology training that can support equity and result in a diverse workforce (BPS, 2020a).

Contextual factors

The study was impacted by COVID-19 affecting how clinical psychology training was conducted. One of the focus groups was conducted before the UK lockdown, and others remotely during the lockdown. The discourse around the Group of Trainers in Clinical Psychology Training Conference (ACP, UK, 2019) and The Black Lives Matter movement may have led to efforts to encourage diversity within the profession, potentially resulting in an interest in identity and discourse in the study.

Strengths and Limitations

This was the first study to explore identities of clinical psychology training trainers through focus groups. Of note, separate focus groups of EBEs and carers enabled an understanding that these roles are qualitatively different, who are often grouped together. Methods of connecting groups were identified. A limitation is that the focus group methodology may have exacerbated perceived group differences. If the focus groups were conducted with members from across disciplines, it may have resulted in different identity formations (Melucci, 1989). The sample lacked diversity, which is symptomatic of the demographics within clinical psychology training. Moving forward further research is required, as identities may shift due to drives encouraging diversity within the profession. Despite the small sample sizes of each focus group, it meant participants could engage in a richer dialogue. The application of social constructionism was subjective, but the research team consisted of experts in clinical psychology training, suggesting integrity to the findings.

This study identified the identities of groups in UK Clinical Psychology training, of EBEs, carers, trainees and EBQs. It acts as ‘The bridge between two different types of knowledge,’ referring to how lived experience connects all stakeholders, despite the parameters of their roles. The research found personal and professional identities were sometimes integrated, separated, permeable, visible, or invisible based on stigma and role expectations. There were Them and Us divisions between groups which were bridged through appropriate language use, by increasing visibility of lived experience, with motivations to expertly engage in coproduction by listening and learning and having opportunities for fluid connections. The study identifies the common aspects of identity of each stakeholder in clinical psychology training, that can promote effective collaboration going forward.

Funding:

This research is funded by a University of Liverpool PhD studentship and covers open access publication fees.

Acknowledgements:

Thank you to all listed authors for your contributions and to all participants that took part.

Data availability statement:

The data that support the findings of this study are available on request from the corresponding author and deposited in University of Liverpool repository.

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The authors declare no competing interests.

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A Social Construction of Identities in Clinical Psychology Training in the Uk: A Focus Group Study

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Abstract

Background

Aims

Methodology

Design

Inclusion criteria

Recruitment

Participants

Ethics

Positionality

Focus groups

Analysis

Results

3.1: Learner

3.2: Expert

Discussion

Dynamics of identity

Separation/Integration/Permeable

Visible/Invisible

Learner and Expert

Bridging Them & Us divisions

Contextual factors

Strengths and Limitations

Conclusions

Declarations

Funding:

Acknowledgements:

Data availability statement:

References

Additional Declarations

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