Popolopolix
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As the title says I suppose, what's the difference?

What's the route towards each of them? What do they consist of/how many years? Are there guaranteed prospects of a job? What kind of pay?

Sorry for so many questions, I'm just in an inquisitive mood
Thanks in advance to whoever answers.
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345rty
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Clinical psychologists usually do a bachelors of psychology if I remember rightly before a couple of years trying to get onto a clinical psychology course for another 4-5 years. They are not medical doctors per se (though the professional qualification is a professional doctorate), and have a nightmarish time getting a job going on the ones I have spoken to of late. Pay has stagnated for them rather a lot and many now start on band five, which is about £25k I think.

Psychiatrists are medical doctors who have specialised in psychiatry. You have to get into and get through medical school then two years of general training before you can apply for psychiatry specialist training. At the moment they are in a bit of a recruitment crisis and its very easy to get a training post (though very many people fail to get through the royal college exams and progress). Job security at the moment is however excellent as they are having huge problems getting people to do the job. Base pay as a speciality trainee is about 30k but you would expect a supplement of 20-50% ontop for antisocial hours.

Recruitment issues tend to run in cycles, just because psychiatry is easy to get into now doesn't mean it will be in roughly ten years, which is about how long it will be before you can apply if you have to get into medical school (earliest start from now is 2015 assuming you can get an application together in time), do your 5-6 years, then two years of foundation.

In my limited understanding clinical psychologists do a lot of talky talky stuff, psychiatrists deal with the more medical aspects, medication, ruling out organic pathology, ECT etc… And ultimately take responsibility for the whole show.
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Dr.Psych
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345rty is partially right, but I wouldn't want you making a decision on incorrect information. I am a final year trainee clinical psychologist, and can answer a few of your questions.

Firstly, clinical psychologists don't just do the 'talky stuff'. We primarily approach problems from a non-medical angle yes, but psychological therapy is not the only string in our bow. We also provide consultation to other professionals, supervision, teaching, training, neuropsychological and psychometric assessment and (sometimes) research. These latter activities have become more common, as psychologists have increasingly had to take on more skills as a race to the bottom ensues in the NHS. On the pay front, clinical psychology in recent years has taken an almighty hit, in that many of the most senior positions (bands 8C+) have been cut, with such posts being regraded to lower banded jobs with the same responsibilities when the individual occupying the post leaves (check agenda for change pay scales for the latest pay). Private companies know this, and have drastically dropped the amount they offer to clinical psychologists for employed posts now, relative to what they used to (CPs used to get jobs ranging from 30-100k, now its more like 30-60k, with experienced jobs being advertised as newly qualified money, and utter disgrace if you ask me). This means that many talented, ambitious psychologists are getting stuck in bands 7-8B, with many either taking on part-time, or whole-time private practice to progress their careers, which can be lucrative if you do well. We take a minimum of 8 years usually to train (3 year degree, several years experience, 3 year doctorate).

Psychiatry on the other hand, primarily deal with assessing patients mental state (often in times of crises), carry out medication review clinics, conduct ECT (which, as an aside, should NOT be used in the NHS due to its terrible evidence base), review mental health act sections, and generally take a lead role in the team, acting in the role of responsible clinician. This is an awful lot of responsibility, but they are very, very well compensated for it. In fact, the only profession not to be severely hammered in recent years by the NHS cuts has been the medical profession, and in this specific case psychiatry. They are a very powerful profession, hold a lot of status, and have positioned themselves well in terms of policy dictating that there MUST be a psychiatrist on hand in a CMHT. Due to this, and the fact that the BMA has a direct strangle hold on the number of training places (thereby manufacturing a chronic shortage) there salaries have not been cut, and there prospects are bright. Salaries run from around 30k-100k+, with many priviate adverts paying over 100k. It does take longer to train, with the minimum time to qualifying as a consultant being around 35 (5 years med school, two years foundation, 8 years+ specialist training). However, you are paid throughout this training very well.

Ultimately, no one can predict how these professions will go, nor can anyone predict how the NHS will end up (privatised as a funding stream to hand out money to private providers IMHO). However, psychiatry will, for the foreseeable future, have brighter prospects and much higher pay than psychology. But you need to decide how important this is, and whether your heart is truly set on psychology or psychiatry.
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katharinakri
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(Original post by Dr.Psych)
345rty is partially right, but I wouldn't want you making a decision on incorrect information. I am a final year trainee clinical psychologist, and can answer a few of your questions.

Firstly, clinical psychologists don't just do the 'talky stuff'. We primarily approach problems from a non-medical angle yes, but psychological therapy is not the only string in our bow. We also provide consultation to other professionals, supervision, teaching, training, neuropsychological and psychometric assessment and (sometimes) research. These latter activities have become more common, as psychologists have increasingly had to take on more skills as a race to the bottom ensues in the NHS. On the pay front, clinical psychology in recent years has taken an almighty hit, in that many of the most senior positions (bands 8C+) have been cut, with such posts being regraded to lower banded jobs with the same responsibilities when the individual occupying the post leaves (check agenda for change pay scales for the latest pay). Private companies know this, and have drastically dropped the amount they offer to clinical psychologists for employed posts now, relative to what they used to (CPs used to get jobs ranging from 30-100k, now its more like 30-60k, with experienced jobs being advertised as newly qualified money, and utter disgrace if you ask me). This means that many talented, ambitious psychologists are getting stuck in bands 7-8B, with many either taking on part-time, or whole-time private practice to progress their careers, which can be lucrative if you do well. We take a minimum of 8 years usually to train (3 year degree, several years experience, 3 year doctorate).

Psychiatry on the other hand, primarily deal with assessing patients mental state (often in times of crises), carry out medication review clinics, conduct ECT (which, as an aside, should NOT be used in the NHS due to its terrible evidence base), review mental health act sections, and generally take a lead role in the team, acting in the role of responsible clinician. This is an awful lot of responsibility, but they are very, very well compensated for it. In fact, the only profession not to be severely hammered in recent years by the NHS cuts has been the medical profession, and in this specific case psychiatry. They are a very powerful profession, hold a lot of status, and have positioned themselves well in terms of policy dictating that there MUST be a psychiatrist on hand in a CMHT. Due to this, and the fact that the BMA has a direct strangle hold on the number of training places (thereby manufacturing a chronic shortage) there salaries have not been cut, and there prospects are bright. Salaries run from around 30k-100k+, with many priviate adverts paying over 100k. It does take longer to train, with the minimum time to qualifying as a consultant being around 35 (5 years med school, two years foundation, 8 years+ specialist training). However, you are paid throughout this training very well.

Ultimately, no one can predict how these professions will go, nor can anyone predict how the NHS will end up (privatised as a funding stream to hand out money to private providers IMHO). However, psychiatry will, for the foreseeable future, have brighter prospects and much higher pay than psychology. But you need to decide how important this is, and whether your heart is truly set on psychology or psychiatry.
I am starting a bachelor in Psychology this autumn, and do you have to take many years between the bachelor and the doctorate??? What do you do?? I am really starting to freak out about my education atm.
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Dr.Psych
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(Original post by katharinakri)
I am starting a bachelor in Psychology this autumn, and do you have to take many years between the bachelor and the doctorate??? What do you do?? I am really starting to freak out about my education atm.
At the moment most people will take between 1-5 years between completing their undergraduate degree to getting onto the DClin. The average age of starting the course was 27/28 the last time I looked. It is incredibly rare for someone to walk onto the DClin straight from undergraduate degree, and usually people will have gained experience in relevant roles after graduation to get a place (assistant psychologist, research assistant, counsellor, support worker, HCA), with some having done further studies (most likely a PG.Dip or Cert, but some M.Sc's and PhD's do occasionally show up on the DClin).

What I would say is that it is a long a tough road, and should not be undertaken lightly, as there are no guarantees of being successful even if you do get the right experience; that said, it increases your chances and people tend to get on the course when they're ready.

Employment prospects are looking ropey for CPs right now, as they are for many healthcare professionals, as the NHS is slowly entering a state of managed decline and as mental health budgets have been substantially slashed. So the future is uncertain for what CP provision will look like in the UK in say, a decades time. But our skills are in demand, and more people are looking at private practice as either an adjunct to their NHS work, or as a full-time role. Only time will tell what's going to happen, and until then I would advise all aspiring CPs to have a back-up plan.
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J1mmy
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(Original post by Dr.Psych)
Employment prospects are looking ropey for CPs right now, as they are for many healthcare professionals, as the NHS is slowly entering a state of managed decline and as mental health budgets have been substantially slashed. So the future is uncertain for what CP provision will look like in the UK in say, a decades time. But our skills are in demand, and more people are looking at private practice as either an adjunct to their NHS work, or as a full-time role. Only time will tell what's going to happen, and until then I would advise all aspiring CPs to have a back-up plan.
This is one of the reasons why I have jumped ship and en route to psychiatry.

CP is a very competitive programme to get onto, this year was my first year of applying, and I managed a reserve interview place, despite my MSc and several years of work as a HCA, Clinical RA etc. It's true the future of CP is uncertain, and I've convinced myself that pursuing it, or investing any more time in meeting what ever criteria they have set for the programme is unwise, and that I need to carry on with my life and start my career.
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Dr.Psych
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(Original post by J1mmy)
This is one of the reasons why I have jumped ship and en route to psychiatry.

CP is a very competitive programme to get onto, this year was my first year of applying, and I managed a reserve interview place, despite my MSc and several years of work as a HCA, Clinical RA etc. It's true the future of CP is uncertain, and I've convinced myself that pursuing it, or investing any more time in meeting what ever criteria they have set for the programme is unwise, and that I need to carry on with my life and start my career.
I'd say you made the right decision. If I could have my time back again, I would have done the same as you, or gone into occupational psychology and gone the consultancy route. But then, hindsight is always 20:20 isn't it!

I can't see your experience- spending years trying to jump the hoops only to get no where- changing any time soon as the DClin is so competitive. But in my opinion, any aspiring CPs should seriously ask themselves about the potential returns for their investment of time and energy. In times of cuts and privatisation, the stronger, more established professions will always fair better, hence why Psychiatry doesn't seem to be having any problems right now.

On the other hand, CPs have been downbanded, had their posts cut, salaries frozen, and the private sector is matching the deteriorating conditions in the NHS as they know they don't need to pay good money to get a CP, despite their extensive training. The only route I see if I want to have access to opportunities to progress and a decent salary (that is, relative to my level of training) is to either work for myself (which is hard, as you need networks for referrals and to have an established reputation), stay in the profession and just hope it gets better (not likely, as public spending will not go up any time soon), or leave the profession entirely and try and find something else to do with my skills. What a waste...
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J1mmy
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(Original post by Dr.Psych)
I'd say you made the right decision. If I could have my time back again, I would have done the same as you, or gone into occupational psychology and gone the consultancy route. But then, hindsight is always 20:20 isn't it!

I can't see your experience- spending years trying to jump the hoops only to get no where- changing any time soon as the DClin is so competitive. But in my opinion, any aspiring CPs should seriously ask themselves about the potential returns for their investment of time and energy. In times of cuts and privatisation, the stronger, more established professions will always fair better, hence why Psychiatry doesn't seem to be having any problems right now.

On the other hand, CPs have been downbanded, had their posts cut, salaries frozen, and the private sector is matching the deteriorating conditions in the NHS as they know they don't need to pay good money to get a CP, despite their extensive training. The only route I see if I want to have access to opportunities to progress and a decent salary (that is, relative to my level of training) is to either work for myself (which is hard, as you need networks for referrals and to have an established reputation), stay in the profession and just hope it gets better (not likely, as public spending will not go up any time soon), or leave the profession entirely and try and find something else to do with my skills. What a waste...
I think you're the first that I've heard this from, which I find refreshing. A lot of trainees, and even CPs which I've spoken to are quite dismissive and in denial of the points you made. I have found people don't see clinical psychologists' services on par with that of psychiatry. This is of course not only reflected in the salary, but is evident right from the beginning where limited funding for training is keeping people re-applying year after year, each time hoping to get a place. Then it continues through the career, whereby salary is restricted to probably a Band 8 or so, where anything higher will probably come after many decades of work.

My original intention was to go into CP back when I was finishing up my undergraduate degree, when I went into research I was working alongside psychiatrists which shifted my whole career direction. I observed how they were the ones calling the shots, having the final word when it came to diagnoses, formulation and treatment, they were typically the directors, the academics, managers. I never once saw a CP have much of an influential place within a department which is reflective of what the NHS still thinks of mental health. What is more, even clinical research studies into mental health require psychiatrists on-site, there is something about having a medical degree that favours ethics boards, a sort of aura which CP's, despite their rigorous application process, can't seem to develop for itself as a profession.

I'm not one for pill-popping, and I hope to also training in psychotherapy so I can offer a more integrative approach to treatment than prescribing drugs, which is my only gripe for going into psychiatry. In some ways it is fortunate that this is happening now. I certainly wouldn't have been happy having gone through the pain of getting onto the training, to find after all that, funding is getting cut and its becoming the profession I certainly wouldn't have applied for originally.

However, it does beg the question that, if you enjoy what you do the salary wouldn't bother you too much. Some people enter careers because they need to feed their families, not caring too much of what their profession is. Others enter a career with a vision of who they want to be as a professional, not debating too much over the declining job prospects or pay, because the profession itself is held highly in terms of reward and satisfaction, and I think for some people, CP can be that career.
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KellyA91
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While both psychiatrists and psychologists are mental health professionals, the big difference is that psychiatrists are medical physicians while psychologists are not. Because they are licensed physicians, psychiatrists can prescribe drugs. Psychologists are not allowed to do that.
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TolerantBeing
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Psychiatrists have a med degree so can prescribe medication. Clinical psychologists don't, so focus on therapy as a treatment. Although they'd often work as a mental health team, and consult together etc. Both are extremely competitive, I'd say the clinical psychologist route is slightly more competitive, because the med degree sets a fair amount of psychology undergrads back.
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TolerantBeing
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(Original post by 345rty)
They are not medical doctors per se (though the professional qualification is a professional doctorate), and have a nightmarish time getting a job going on the ones I have spoken to of late. Pay has stagnated for them rather a lot and many now start on band five, which is about £25k I think.
25k! You've got to be kidding me, after all those years training and work experience...that's awful.

I'm a bit surprised to hear that though, because mental health is taken a lot more seriously in recent years, the APA is pushing for a more clinical focus in psychology undergrads because they've said it's becoming more and more important. But the number of applicants still massively outweigh the number of places I suppose.
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J1mmy
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(Original post by TolerantBeing)
25k! You've got to be kidding me, after all those years training and work experience...that's awful.

I'm a bit surprised to hear that though, because mental health is taken a lot more seriously in recent years, the APA is pushing for a more clinical focus in psychology undergrads because they've said it's becoming more and more important. But the number of applicants still massively outweigh the number of places I suppose.
I often apply for assistant psychology jobs on the NHS website, and its true that I've never come across a CP post where the salary is more than about £60K, most of which are around £40K or so. But mind you, the NHS will pay the best part of about 100K training you for 3 years. However, I think more and more self-funded places are going to emerge.

Pushing for more importance in CP is no use when the access is not widened enough to let more graduates train. I believe the application process is fundamentally broken. I have no sympathy for the NHS when it says they're not enough CPs to aid their services - they need to overhaul their application process, and allow more people to fund their own places on training, that way there will be an increase in the number of CPs, without any cost to the NHS.

And what is more, because of the poor pay, more CPs seems to be ending in private work and doing a few days a week in the NHS. I know my supervisor for example, used to spend 4 out of the 5 days working privately, he was raking it in and I can understand why when the maximum you'll probably get as a consultant is probably equivalent to a senior registrar in psychiatry.
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Dr.Psych
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(Original post by J1mmy)
I often apply for assistant psychology jobs on the NHS website, and its true that I've never come across a CP post where the salary is more than about £60K, most of which are around £40K or so. But mind you, the NHS will pay the best part of about 100K training you for 3 years. However, I think more and more self-funded places are going to emerge.

Pushing for more importance in CP is no use when the access is not widened enough to let more graduates train. I believe the application process is fundamentally broken. I have no sympathy for the NHS when it says they're not enough CPs to aid their services - they need to overhaul their application process, and allow more people to fund their own places on training, that way there will be an increase in the number of CPs, without any cost to the NHS.

And what is more, because of the poor pay, more CPs seems to be ending in private work and doing a few days a week in the NHS. I know my supervisor for example, used to spend 4 out of the 5 days working privately, he was raking it in and I can understand why when the maximum you'll probably get as a consultant is probably equivalent to a senior registrar in psychiatry.
I would contest one point previously mentioned. I don't think people view Psychiatry as instinctively better quality services. In fact, many people would argue that medication in many instances does little more than offer a temporary pharmacological boost to allow someone to engage in tackling the root of the problem through complex psychological therapy. I think that the preferential treatment afforded to Psychiatry in recent years has been due to the way the NHS is run, and the tendency for the NHS to resort to the devil it knows in times of austerity. Keep in mind that medics hold the purse strings for the NHS now, and that over 50% of GPs believe medication is the best treatment for mental health, despite the evidence saying they're wrong. So they will commission medically orientated services, which is also an artefact of the NHS often switching back from newer, but more advantageous forms of provision to a more medically focused model, as the medical model is quick and cheap (at least in the short term).

But I do agree that most posts in the NHS or advertised with private employers don't go over 60-70k, with the vast majority being in the 30-50k bracket. It didn't used to be this way at all when mental health was well funded, and we had a more progressive government in charge. In fact, before the recession it wasn't rare at all to see plenty of senior CP posts ranging from 55-100k in the NHS and private sector. But in times of austerity,budgets are constrained, wages are forced down, and we resort to the old, biomedical models of provision.

This isn't to say that there isn't a demand for CP services in the UK. I've heard of many examples of CPs who work for themselves in the private sector being so overwhelmed with demand for their services that they're having to turn work away, and can walk away with 60k+ in salary easily. However, these people usually have 5+ years of experience under their belt, a good reputation, and a healthy network from which referrals come. This is not an easy point to get too. Obviously, this would all be helped if we had a more influential, vocal and powerful representative body like the medics do. Compared with the BMA, the BPS is toothless and fractured. There is a campaign for a Royal College of Psychologists to be established, but we'll wait and see on that one!
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J1mmy
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(Original post by Dr.Psych)
I would contest one point previously mentioned. I don't think people view Psychiatry as instinctively better quality services. In fact, many people would argue that medication in many instances does little more than offer a temporary pharmacological boost to allow someone to engage in tackling the root of the problem through complex psychological therapy. I think that the preferential treatment afforded to Psychiatry in recent years has been due to the way the NHS is run, and the tendency for the NHS to resort to the devil it knows in times of austerity. Keep in mind that medics hold the purse strings for the NHS now, and that over 50% of GPs believe medication is the best treatment for mental health, despite the evidence saying they're wrong. So they will commission medically orientated services, which is also an artefact of the NHS often switching back from newer, but more advantageous forms of provision to a more medically focused model, as the medical model is quick and cheap (at least in the short term).

But I do agree that most posts in the NHS or advertised with private employers don't go over 60-70k, with the vast majority being in the 30-50k bracket. It didn't used to be this way at all when mental health was well funded, and we had a more progressive government in charge. In fact, before the recession it wasn't rare at all to see plenty of senior CP posts ranging from 55-100k in the NHS and private sector. But in times of austerity,budgets are constrained, wages are forced down, and we resort to the old, biomedical models of provision.

This isn't to say that there isn't a demand for CP services in the UK. I've heard of many examples of CPs who work for themselves in the private sector being so overwhelmed with demand for their services that they're having to turn work away, and can walk away with 60k+ in salary easily. However, these people usually have 5+ years of experience under their belt, a good reputation, and a healthy network from which referrals come. This is not an easy point to get too. Obviously, this would all be helped if we had a more influential, vocal and powerful representative body like the medics do. Compared with the BMA, the BPS is toothless and fractured. There is a campaign for a Royal College of Psychologists to be established, but we'll wait and see on that one!
Good points mentioned, took the words right out of my mouth. This is exactly why I am leaving for psychiatry.

Whilst psychiatry is not a 'better' discipline in tackling mental health than CP, the fact that it is more mainstream, better funded and highly regarded by the NHS as a profession that cuts costs (giving the pill vs therapy) makes it appear so to the layman and sometimes prospective applicants as the 'better' of the two. I certainly for one see it more influential in the mental health sphere more so than CP for the points you've mentioned, which is a shame as having experienced the perspective of both professions, it does appear CPs have a more valuable role to play - the NHS is not denying this as it is demonstrated in way of demand for psychological services.

I would argue the BPS is a useless organisation that rides the back of the APA majority of the time - after all the clinical psychology doctorate was an invention of the Americans. The BPS has no grounding or self-worth which in some ways is spilling out into the profession which as a result causes drastic cuts due to not being able to stand up for itself against the formidable opponents who are the BMA, RCPsych and RSM. This also extends to research grants. One psychiatrist told me to choose medicine as you're most likely to have access to money especially for medics, and there are generally better prospects as an academic if you hold a medical degree than if you don't, or similarly if you have a DClin.

All of the above points haven't anything to do about the salary either, if we include that, we've got a clear winner.
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Dr.Psych
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(Original post by J1mmy)
Good points mentioned, took the words right out of my mouth. This is exactly why I am leaving for psychiatry.

Whilst psychiatry is not a 'better' discipline in tackling mental health than CP, the fact that it is more mainstream, better funded and highly regarded by the NHS as a profession that cuts costs (giving the pill vs therapy) makes it appear so to the layman and sometimes prospective applicants as the 'better' of the two. I certainly for one see it more influential in the mental health sphere more so than CP for the points you've mentioned, which is a shame as having experienced the perspective of both professions, it does appear CPs have a more valuable role to play - the NHS is not denying this as it is demonstrated in way of demand for psychological services.

I would argue the BPS is a useless organisation that rides the back of the APA majority of the time - after all the clinical psychology doctorate was an invention of the Americans. The BPS has no grounding or self-worth which in some ways is spilling out into the profession which as a result causes drastic cuts due to not being able to stand up for itself against the formidable opponents who are the BMA, RCPsych and RSM. This also extends to research grants. One psychiatrist told me to choose medicine as you're most likely to have access to money especially for medics, and there are generally better prospects as an academic if you hold a medical degree than if you don't, or similarly if you have a DClin.

All of the above points haven't anything to do about the salary either, if we include that, we've got a clear winner.
I agree with all points you've said. I think you hit the nail on the head about the BPS, and more generally CPs having some sort of collective low self-esteem. This manifests itself in the incredibly frustrating, but frighteningly common narrative in many psychology departments that the cuts to CP which are happening right now are some sort of natural adjustment, as though the increased funding, status and salaries that came following the MAS report and agenda for change were too much and that we didn't deserve it. In fact, you look at what a lot of CPs are doing right now, and actually you'll see many CPs banded at 8a are doing the work of 8b's and 8c's, and many 8c's are doing the work of 8d's and even 9's. Which is a disgrace when you think about it; it's like a psychiatry registrar doing the job of a consultant. It just wouldn't happen. But I fear this will continue until a more progressive government gets in power, funding is increased, and the profession and it's representative body grows a backbone and stands up for itself more.

Good luck with your career.
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Xpopat
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Being in my first year of University studying undergrad psychology, I'm finding the road to become a Clinical Psychologist very long. I'm doing a placement year next year so I should hopefully secure a place as an Assistant Psychologist... but reading after reading stories about people getting onto their Clinical Psychology course after years of experience is very daunting. Especially considering the amount of debt I will already be in after completing my undergrad course in Psychology.
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kat19892012
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(Original post by Xpopat)
Being in my first year of University studying undergrad psychology, I'm finding the road to become a Clinical Psychologist very long. I'm doing a placement year next year so I should hopefully secure a place as an Assistant Psychologist... but reading after reading stories about people getting onto their Clinical Psychology course after years of experience is very daunting. Especially considering the amount of debt I will already be in after completing my undergrad course in Psychology.
Have you looked into other related careers such as mental health nursing or as a cbt therapist(or other therapies). Mental health nursing is funded by the nhs.

I have a psychology degree and will be going back to uni in september to train in mental health nursing.
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Asclepius1
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(Original post by Dr.Psych)
345rty is partially right, but I wouldn't want you making a decision on incorrect information. I am a final year trainee clinical psychologist, and can answer a few of your questions.

conduct ECT (which, as an aside, should NOT be used in the NHS due to its terrible evidence base).

Interesting aside. Cochrane disagree with you... "ECT is an effective short-term treatment for depression..." In addition, it would create an incomplete picture to castigate ECT for lack of evidence (incorrectly), without also mentioning that few psychological interventions are backed up by systematic review. One that has been is CBT...which is equally effective when delivered by a psychologist or a computer

To the OP: despite common misconceptions, psychology and psychiatry could not be more different from one another. Their entire approach, belief-system and philosophy are poles apart. If considering either, I would suggest some work experience would help you decide which may be for you.
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J1mmy
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(Original post by Asclepius1)
Interesting aside. Cochrane disagree with you... "ECT is an effective short-term treatment for depression..." In addition, it would create an incomplete picture to castigate ECT for lack of evidence (incorrectly), without also mentioning that few psychological interventions are backed up by systematic review. One that has been is CBT...which is equally effective when delivered by a psychologist or a computer

To the OP: despite common misconceptions, psychology and psychiatry could not be more different from one another. Their entire approach, belief-system and philosophy are poles apart. If considering either, I would suggest some work experience would help you decide which may be for you.
But compared to what; not in the face of (new) emerging Ketamine it isn't. There is no clear basis of understanding of how ECT works in the brain. It is reserved typically for depressive-resistant patients, the people who have no other choice of treatment, but ECT. And I like to think that even psychiatrists use it hesitantly with a combination of other things, not least of which being a form of CBT (which I know is probably untrue). And I wouldn't pass ECT as a form of treatment at all, it marketed as that to the patient. It's something borrowed from the emergence of psychiatry in the 20th century and made to look less horrific with the use sedation, mouth guards and straps only because it mentally knocks the patient out until the brain recalibrates itself to its original depressed state, then the cycle begins again.

It can be argued that patients progress onto such severe depression because they're not well looked after in their earlier stages. It has been shown CBT to be more effective than anti-depressants so this warrants the question that had they had psychological intervention much earlier, they probably wouldn't have progressed so drastically.
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(Original post by J1mmy)
But compared to what; not in the face of (new) emerging Ketamine it isn't. There is no clear basis of understanding of how ECT works in the brain. It is reserved typically for depressive-resistant patients, the people who have no other choice of treatment, but ECT. And I like to think that even psychiatrists use it hesitantly with a combination of other things, not least of which being a form of CBT (which I know is probably untrue). And I wouldn't pass ECT as a form of treatment at all, it marketed as that to the patient. It's something borrowed from the emergence of psychiatry in the 20th century and made to look less horrific with the use sedation, mouth guards and straps only because it mentally knocks the patient out until the brain recalibrates itself to its original depressed state, then the cycle begins again.

It can be argued that patients progress onto such severe depression because they're not well looked after in their earlier stages. It has been shown CBT to be more effective than anti-depressants so this warrants the question that had they had psychological intervention much earlier, they probably wouldn't have progressed so drastically.
The quality of the studies that comprise these reviews is terrible. A lot of them have poor control groups, or no control groups at all, and many of them had dependent variables which were based on clinician's opinions about how much the client improved. Many of the studies which have used good control groups and valid outcome measures have poor evidence of effectiveness relative to controls. Add that to the horrific side-effects ECT can cause and the poor knowledge of the mechanisms underpinning it, and it's fair to say that in other areas of medicine, such a poorly understood, evidenced and potentially damaging treatment would not be approved. Frankly, I know of way too many instances whereby ECT was not used as a last resort, and where psychological therapy could have been, but wasn't used.
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