Dr Chris Groot Interview

You play a key role in teaching clinical psychology at undergraduate level. What are some of the opportunities and challenges of teaching this potentially confronting material to students?

Teaching undergraduate clinical psychology in the School is certainly a privilege, but as you say, comes with unique challenges. Most of the content delivered in clinical classes deals with sensitive, real-world issues, like anxiety, depression, psychosis, suicide, and so forth. This content is likely to be confronting to some degree for many students, and particularly those who have been affected by mental illness, either directly or vicariously. Also, emerging social trends in student populations in terms of anti-psychiatry and trigger warning movements have added another layer of complexity to the teaching of clinical psychology in recent years.

I think the important thing in developing an approach to teaching of undergraduate clinical psychology is to be observant of these trends, to present content in a sensitive and mindful manner, to be flexible and accommodating where appropriate, but also to be firm and clear about the limits of this flexibility. While the subject content is sensitive and contentious for some, it is unavoidable as part of a comprehensive undergraduate psychology course, in my opinion.

Pragmatically, there are a number of steps that can be taken to increase the accessibility of the undergraduate clinical course content for all students. For example, a useful start is to provide an initial disclaimer acknowledging the sensitive nature of the content to come and its confronting nature. Sources of clinical support can be discussed, as can students’ personal responsibility for self-care, strategies to deal with triggers such as advanced release of materials can be outlined, and assurances can be provided that issues will be explored purely from an academic perspective.

I find it’s also useful to acknowledge at the outset that the viewpoint presented in undergraduate clinical psychology – that of western psychiatry and clinical psychology – is just one of the possible ways one could think about psychological experience. The acknowledgement that some students have alternative views provides freedom to move on and present an account of clinical psychology that is relatively unencumbered by the pressure to repeatedly defend its position. I think this validation also creates a space where students with competing views may feel more open to considering the validity of the presented content, and how this sits with prior beliefs. Of course, these are just a couple of highlights and there’s a lot more that goes into creating an accessible and risk-sensitive clinical undergraduate subject.

As you say, the challenges of my role are balanced by opportunities. Certainly, if I can provide students with new and hopefully helpful ways of thinking about mental disorder and the human experience, then that’s a valuable opportunity seized. If I can also take advantage of the opportunity to capture students’ interest in clinical psychology and encourage them to pursue that, then that’s an added bonus. I’m cognizant that undergraduate clinical psychology is a key point at which we can inspire the next generation of clinicians, and this is something I am always striving to do, having seen first-hand the need for a growing mental health workforce at the national level.

How do you make clinical psychology real to students? Are there any innovation you have brought in to make clinical psychology ideas more vivid or to dispel common misunderstandings?

That’s a good question. So many of the topics presented in the clinical undergraduate curriculum may be hard to imagine for those without lived experience. This year, we have attempted to address this in two important ways in our third-year clinical psychology subject, ‘The Psychopathology of Everyday Life’. The subject title, previously adopted by the Melbourne School of Psychological Sciences’ Emeritus Professor Henry Jackson, is a tip of the hat to Freud’s seminal work of the same name, which discussed the idea that signs and symptoms of mental illness seen in clinical populations can also be observed in the non-clinical population, but in attenuated forms. This idea of a continuum of experience relating to psychopathology is something that we placed new focus on this year in an attempt to bring topics to life, through the inclusion of innovative content and opportunities for students to explore what mild, common and unproblematic experiences of symptom phenomena might be like, in addition to those seen in clinical presentations.

In addition, our very own Dr Abi Brooker and I have created an entirely new suite of undergraduate clinical practical classes in 2017 in order to make concepts more vivid for students. While the undergraduate clinical curriculum is necessarily broad in scope, each one of these classes explores one topic only, and explores it in depth. For example, one practical class explores the phenomenon of auditory-verbal hallucinations, or hearing voices, which is most associated with psychotic disorders, but is also experienced in other disorders and by a small proportion of the non-clinical population. This tutorial seemed to receive rave reviews from our students. In particular, students reported appreciating that I had consulted with consumer members of an international voice hearer’s network in the process of designing the activities and content of the practical class. Indeed, consumer consultation and co-creation is a particular area of innovation I am currently pursuing as part of curriculum redesign.

Of course, beyond curriculum design itself, I am proud of the incredibly strong cohort of clinical staff who also teach into our third year subject, including A/Prof Lisa Phillips, Dr Audrey McKinlay, Dr Isabel Krug, Dr Scott Griffiths, and our select tutors, who are senior students in our clinical programs. The experience and insights that they bring to the program are invaluable in engaging students and bringing clinical content to life.

You have a background in crisis support and e-therapy. How does that influence your academic work?

It’s true, I’ve had the unusual privilege of governing some of the biggest professional telephone- and web-based mental health services in Australia, like the national Suicide Call Back Service, beyondblue’s telephone referral/counselling services, services for the Australian Defence Force, and more. This experience certainly has influenced my academic work in numerous ways.

I’m definitely an advocate for remote clinical service delivery, not as a replacement for face-to-face therapy, but as a mode of clinical practice that is particularly useful for crisis intervention, as an adjunct to face-to-face therapy to ensure continuity of care, or as a pathway to treatment and support for those who may be unable or reluctant to speak with a psychologist in person in the first instance. Certainly, there is good empirical evidence emerging as regards the efficacy and effectiveness of interventions in this space, and particularly around adapted CBT [cognitive behaviour therapy] interventions and high prevalence disorders. Discussion of this emerging evidence, and the benefits, downsides, and limitations of remote therapy is something I have worked into the first-year clinical curriculum in recent years, and feedback indicates that this is something that students are increasingly interested in exploring further.

I also certainly draw inspiration for teaching from my time in large scale mental health service delivery. I think it’s common that academics can feel disconnected from the coal face - from ‘real world’ issues - in their teaching. I am quite fortunate in this way, in that I clearly perceive a direct connection between our undergraduate clinical teaching and Australia’s growing need for professional mental health services. I think of our MSPS students as the next generation of mental health workers going out into the community, some following postgraduate training in our elite postgraduate programs, and others following bachelor or honours degree graduation, and this constantly reminds me that my role carries both profound privilege and responsibility.

Your research is unusual in that it bridges clinical psychology and the psychology of perception. Can you tell us a little about how that combination illuminates the study of hallucinations, for example?

One doesn’t have to try too hard to consider the possibility that an aberrant perceptual experience like hearing voices may be associated with some sort of problem with sensory and perceptual processing. This has been long suspected based on clinical observations and on non-clinical, naturalistic observations of hallucinations in situations where sensory input is reduced. For example, people restricted to quiet, solitary confinement situations have reported hearing voices.

This idea has been supported in recent research, including my own. Emeritus Professor Henry Jackson, Professor Susan Rossell (Swinburne University), and I recently found evidence suggesting that people with schizophrenia who hear voices have problems processing fundamental components of sound when compared to people with schizophrenia who don’t hear voices and non-clinical controls. Processing pitch, complex sound, and sound over time, seems to particularly be a problem for this group of people. It could be that this impoverished sensory processing sets the scene for higher-order cognitive processes to become overactive, modulating the impoverished sensory input, and resulting in aberrant perception. This is just one possibility that I have been more recently exploring along with Dr Simon Cropper in our Hallucination Lab here in the MSPS. We are currently extending this work to investigate sensory and perceptual processing, and hallucination proneness, in non-clinical samples as a function of personality traits thought to be related to schizophrenia and bipolar disorder. In doing so, we hope to better understand the continuum of hallucination experience, from relatively fleeting, subtle, and commonplace unusual perceptions like hearing your name called in a busy café, through to the florid and clinically significant hallucinations that can be observed in psychosis.