2.2 Potential sources of conflict

Multidisciplinary teams, which comprise a range of different professions, can be effective because they combine a range of skills and perspectives to help a young person. Although they aim to work together for the benefit of the young person they are helping, there can potentially be conflict between professions, partly because they might be taking different perspectives on diagnosis and treatment. Family members may also feel in conflict with healthcare professionals if they have strong personal views on the use of medication or talking therapies, or labelling their children with a stigmatising diagnosis.

Clinical Psychologist Lucy Johnstone argues that a medical diagnosis ‘turns “people with problems” into “patients with illnesses”’ and that this can be damaging because the medical meaning essentially displaces the person’s own understanding of their situation and their sense of self (Johnstone, 2018, p. 31). Moreover, she continues, psychiatric diagnoses commonly lead to a sense of stigma and shame ‘by locating the difficulties within the person’ (p. 35) rather than their social environment and life story.

The psychologist’s alternative to a medical diagnosis lies in the ‘psychological formulation’. According to Johnstone (2018, p. 39), ‘it is the difference between the message “you have a medical illness with primarily biological causes” and “your problems are an understandable emotional response to your life circumstances.”’ In creating a psychological formulation, the service user and the practitioner combine their knowledge and skills and together reach a ‘best guess’, or hypothesis, about the roots of the problem and agree a way to move forward.

The next activity will allow you to compare and contrast the perspectives of a psychiatrist and a clinical psychologist as they explain their professional allegiances and discuss how they would help a young woman called Mandy.

Activity 6: A psychiatrist and a psychologist

Timing: Allow about 20 minutes

Watch the two videos of a psychiatrist Dr Elizabeth Venables and a psychologist Dr Marion Bates talking about their work. What are the similarities and differences? Can you identify any potential source of conflict?

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Transcript: Video 2: Dr Elizabeth Venables

Dr Elizabeth Venables

My registration board is called the General Medical Council. It’s often abbreviated to the GMC. And it’s very important because as a doctor you’re doing things which hopefully do good, but can also do harm if they’re not done properly. So it says what the minimum standards are that we are expected to meet and make sure that doctors are scrutinised. And if they don’t meet those minimum standards they can’t continue to practise.

Psychiatrists help service users or patients, I suppose, as we call them, with mental health issues in a number of different ways. The way that is specific to psychiatrists is that they can treat with medication, which involves also making a diagnosis or a list of differential diagnoses. But as well as prescribing, we also as part of our training learn various sorts of talking therapies. And so we would use those both in how we treat patients, but also how we understand how patients develop mental illnesses. And so that would also come into our day-to-day work.

And we work within a multidisciplinary team. And we often have a fairly central role in terms of overseeing how the different professions work together and leading teams in that way. With Mandy, the sorts of interventions I would be thinking of are, well, broadly classed as biological, psychological and social interventions. But the things that I would be thinking of in terms of, say, the things I can do specifically are, medication is central, I suppose. It’s not exclusive, but it’s very important.

So I would be doing a full assessment of Mandy, and that’s basically finding out about someone’s life history and also finding about their family and getting them to describe in as much detail as possible what the problems are that have arisen. And that in itself can be therapeutic because if you tell someone your life story and explain the things that have been making them suffer that can make a person feel better in itself.

But from that account, what I would be doing is trying to arrive at a list of different diagnoses that might apply to that person and I’d be thinking about the treatments that you’d be using for each of those. And those would include medication. They would also include different therapies and also thinking about how I could use the input of my colleagues who provide other specific inputs.

End transcript: Video 2: Dr Elizabeth Venables

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Video 2: Dr Elizabeth Venables

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Transcript: Video 3: Dr Marian Bates

Dr Marian Bates

I’m a clinical psychologist. Some service users may refer to me as a psychologist or as their therapist or sometimes the psychotherapist. I’m chartered with the British Psychological Society. I’m also a practitioner psychologist registered with the Health Care Professions Council.

It’s very important to be registered with both of those bodies. One of them, the British Psychological Society, is a professional body, and the Health Care Professions Council registers a whole range of Health Care Professionals, including psychologists. And it’s important because there are certain protected titles that some types of psychologists can use. And service users need to know that they can trust the therapists they’re seeing, and also that they would have a body to complain to if something goes wrong.

Working in a community mental health team, we all work together, valuing each other’s roles. Psychologists would predominantly look at a formulation of a client from this holistic biopsychosocial model. We’re also in a way different because we see ourselves as scientist-practitioners. So everything that we do is grounded in evidence that has been done across the world, looking at different therapies and different models of working with people.

We’re different from our medical colleagues because we don’t have a medical training, and we cannot prescribe medication. And we would veer away from using medication as a way to work with people’s difficulties. But we are not against medication per se, sometimes it can work in conjunction with therapy.

Somebody like Mandy may be experiencing a first episode of psychosis. She’s experiencing voices. And I would, as a psychologist, steer away from giving her a label or a diagnosis. So I may not even use the word psychosis. I would use the words that Mandy brings to the sessions to really understand and explore what’s going on for her. So what’s happened now she’s come into therapy? Why is it that now things seem to have gone bad for her? And I would be wanting to explore her past with the aim to get a formulation, so really a story of her life.

So thinking about when she was a child, some of the difficulties she may have had, she learned coping strategies to get by. And these are developed into deeply rooted behavioral patterns, really, that, as a grown up, are no longer really working for her. So I’d be looking to identify those patterns and work out exits from those patterns so that she can develop more adaptive ways of behaving and thinking so that she can move forward with her life.

End transcript: Video 3: Dr Marian Bates

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Video 3: Dr Marian Bates

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Table 2: Similarities and differences

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Discussion

Comparing and contrasting are useful analytical skills that are commonly used in academic and professional life.

Table 2 (completed): Similarities and differences

Similarities

They both have to be registered with a professional body or council. They are both interested in finding out about the person’s life story and the therapeutic benefits of talking. Both recognise the biological, psychological and social aspects of mental health.

Differences

The psychiatrist is medically trained and can prescribe medication and in fact medication appears to be central to her work. By contrast, the psychologist does not prescribe medication. The psychiatrist aims to arrive at a diagnosis, whereas the psychologist avoids making a diagnosis and works with the client’s own language for describing and understanding their problem. There seemed to be the potential for conflict over whether or not a diagnosis was needed.

Next, you’ll consider the role of social media in shaping perceptions of mental health.