I will now note the clinical implications of this study and suggest some recommendations for the profession and for UK clinical psychology training courses.
4.2.1 Sharing knowledge about the profession.
Within this study, participants spoke about how they had to actively seek out
knowledge about the profession and how to get onto clinical training. This could imply that the lack of awareness of the profession and the route to becoming a clinical psychologist may not be as clear as other professional routes which are more common for people from BAME
backgrounds, such as medicine. Some initiatives which have looked at attracting people from BAME backgrounds into the profession, have begun to reach out to these communities from an earlier stage at high school (Scior et al., 2016). This is something which should continue to be done throughout the UK, including in lower socio-economic status areas. These initiatives may also benefit from being explicit about the stigma around mental health within BAME communities and how this can often be hidden or not spoken about. Discussion around some of these issues with students from BAME backgrounds may help to facilitate decision making around choosing this career path.
4.2.2 Implications for Undergraduate Psychology Courses.
It appeared that over half of the participants were able to gain initial clinical
experience via a sandwich placement year, which was embedded within their undergraduate course. Therefore, having a year where they can gain more understanding and experience within the profession may be a helpful way to attract more BAME applicants into the profession. The heart of this issue may be related to socio-economic status. By having a placement year as part of the course, may provide the opportunity for people who don’t have the finances to volunteer to gain important clinical experience.
Additionally, participants spoke about how issues related to difference and diversity tended to be treated as an “add-on” at the end of lectures, rather than being seen as a key concept within their teaching. An implication of this could be to include issues of difference and diversity at an undergraduate stage as a meaningful part of the curriculum. This may help BAME students to feel more comfortable raising these issues and may show them that White lecturers and supervisors are able to take responsibility in raising these issues too.
4.2.3 Implications for the pursuit of clinical training.
Participants raised concerns in relation to not feeling they were able to raise issues of race and culture. Thus, an implication of this could be the suggestion that training could be offered and provided to supervisors which should highlight the necessity of raising issues around culture and race routinely with all supervisees. This will aid in applicants from
BAME backgrounds to feel validated and understood by their supervisors, irrespective if their supervisor is from a BAME background or not. This will also ensure that issues around race and culture are not solely left to BAME professionals to address and thus may alleviate some of the perceived burden. This may also allow BAME applicants opportunities to feel
supported by senior colleagues. Furthermore, this could allow them to reflect on their experiences and how this impacts their clinical work and professional development. In turn, they may be better prepared for other challenges they may face throughout their training experience. By engaging with supervisor training which addresses these difficult issues, there may be opportunity for practitioners to engage with issues related to difference in a fruitful and meaningful manner. It would be important that this is not achieved in a tokenistic manner, which may defeat its purpose, but in a thoughtful manner that is inclusive (Nolte & Nel, 2012). Additionally, this endeavour can be achieved by CPD courses which highlight issues around difference and provide examples of best practice when working in a culturally sensitive manner with colleagues and service users from BAME backgrounds.
Furthermore, with regards to the development of their professional identity,
participants spoke about the difficulties they experienced in relation to being different to the White norm. With further training, supervisors may better able to support BAME applicants to consider and develop their professional identities, whilst acknowledging the White norm and finding ways to move beyond this.
Participants within this study also spoke about the importance of having role models. Therefore, these initiatives and schemes speak to this importance. As previously mentioned, research has highlighted the low rates of ethnic diversity within the clinical psychology profession (Smith, 2016; Turpin & Coleman, 2010; Turpin & Fensom, 2004). Initiatives have been implemented to attract people from BAME groups and backgrounds into the profession (Scior et al., 2016), and should continue to be an on-going focus for the profession. Having mentors from different stages of clinical psychology, e.g. trainee clinical psychologists and qualified clinical psychologists, would allow the support to be maintained for potential BAME applicants. In line with this, is the introduction and implementation of social/ online groups which are founded and run by people from BAME backgrounds. Groups such as the Minorities Group, which is part of the Division of Clinical Psychology Pre-Qualification Group provide a platform and opportunity for people who consider themselves to be minorities in this profession, to make connections and alleviate the feeling of loneliness which was described by many participants in this study and in previous studies (Odusanya et al., 2017; Shah et al., 2012; Rajan & Shaw, 2008). Additionally, having mentors from BAME backgrounds may allow a safe space for reflection in order to consider issues around the navigation and integration of personal and professional values, in a way that feels true and authentic to themselves (Daniel, 2009). It may also be important to consider White mentors in addition to BAME mentors. This may highlight that the responsibility of integration lies with all psychologists and not just those from BAME backgrounds.
4.2.4 Implications for clinical doctorate courses.
The findings from this study show that participants found it difficult to initially find relevant jobs and spoke about not being able to take on honorary positions as they needed to have paid jobs. This speaks to the somewhat inflexible route to gaining a place on doctorate
programmes. It may therefore be useful for doctorate courses to be more explicit in terms of their flexibility in relation to relevant experience. This however, may tie in with an earlier implication of offering placement years within undergraduate study in order for applicants to begin gaining relevant clinical experience.
Participants spoke of being more attracted to courses which placed emphasis on cultural diversity in teaching and research as it allowed them to feel heard and understood. In order to attract BAME applicants, training courses should be more explicit about their
commitment to supporting applicants and trainees from these backgrounds (Patel et al., 2000). It may be helpful to provide clarity around why BAME applicants are encouraged and to explicitly state that courses are looking to diversify cohorts in order to diversify the
profession; and perhaps highlighting why there is a need to diversify the profession. This may aid in BAME applicants feeling worthy of gaining places, rather than believing they are meeting course quotas (Adetimole et al., 2005).
There are some doctorate courses who offer specific open days for BAME applicants. This may be helpful if it was systematically done across all courses in order to attract BAME applicants across the UK and to encourage diversity as a profession, rather than be limited to certain areas within the UK.
Finally, it has been mentioned in the introductory chapter that proportionally fewer BAME applicants are accepted than those who apply. Therefore, it will be important to consider the interview process and the biases that may exist at this stage, which has been suggested in this research. It may be likely that the majority of those conducting interviews are representative of the profession norm, i.e. White British women. It may be possible that the “homophily” principle could apply here in that they are looking for qualities in candidates that are more similar to them. An implication of this could be to include more BAME
psychologists in selection procedures. Additionally, training could be provided to
psychologists who are involved in selection procedures on how to recognise their own biases.
4.3 Strengths and limitations of the study