Clinical Practice Reports

Length: 5,000- 6,000 words excluding references and appendices*

Consisting of a 4,000-5,000 word Clinical Report PLUS 1,000 word (approx) Focused Reflection on an area of learning.

*Tables, diagrammatic formulations, headings and text boxes within the main report are included in the word count. Appropriate, additional information can be included as appendices

Introduction

Each trainee will be required to submit 4 Clinical Practice Reports (CPR) during their training.  Typically, these will be submitted after completion of placements 1-4 respectively and will describe work done on each of the trainee's first 4 placements. The CPRs are an opportunity for trainees to demonstrate at the end of each placement where they are in their own developmental journey regarding their acquisition of the essential competencies of a clinical psychologist (see link below):

Each CPR will consist of a case report describing the work done on placement and a separate, focused reflection on one of four areas of the trainee's learning (Supervision, Process, Personal & Professional Development, Inter-Professional Learning).

We recognise that clinical psychologists undertake a huge variety and diversity of work whilst on placement in our local health and care systems and our intention is for the requirements of the CPRs to be accommodating of trainees writing up the reality of the work they have completed. 

It is important to hold in mind that whilst each report should describe a piece of work completed during the placement, this is to serve as a vehicle to the primary purpose of demonstrating the trainee's developing competency as a clinical psychologist, and their insight into this.

Each CPR should describe how the trainee has understood and applied relevant and appropriate psychological knowledge and skills within the work they have completed and should demonstrate self-reflection and a critical evaluation of their own personal and professional development at the given stage of training. 

Typically, trainees have chosen to write up a single piece of work described chronologically, but they may find describing an amalgam of multiple pieces of work undertaken on placement a better means of demonstrating and reflecting on their competency. This approach is equally acceptable so long as the different elements of work are clearly described. 

Particular emphasis in each CPR should be placed on the trainee's own psychological formulation of the work and should demonstrate their understanding and critique of the relevant psychological literature and evidence-base and how this translates within real-life settings. Consideration of the individual/organisational/systemic context around the work might also be an important focus.

Each CPR should describe the trainee's journey of engaging with and undertaking the work they have completed on placement (the process) and the learning and development they have taken from this. Trainees may find it helpful to draw from recordings of sessions, supervision notes or any written communications (letters, reports etc) they have produced as part of the work to support their reflections. 

CPR Requirements

Trainees are required to submit one clinical practice report describing work they have undertaken as the principal practitioner* on each placement completed in the first two years of training along with a self-assessment of their clinical competence at each point.

*It is acceptable to write up joint work carried out with other psychologists or members of an MDT, but in these cases the trainee must have been the main person conducting the work rather than supporting or observing the work of someone else. In all cases of joint work, it must be made clear which procedures were carried out by the trainee and which by a co-worker. The trainee must take complete responsibility for the whole of the written submission. 

The work described should demonstrate an appropriate depth of psychological practice, reflective of the work commonly undertaken by clinical psychologists. This is typically considered to mean a piece of work which has involved multiple sessions/contacts with clients, carers, or family members, and/or multiple meetings, consultations, telephone calls or correspondence with professionals, where there has been application of doctoral-level psychological knowledge and skills. 

By the end of training, it is essential that graduating clinical psychologists can apply their psychological knowledge and skills in multiple settings and in service to multiple different needs and presentations. Taken together therefore, the 4 Clinical Practice Reports should demonstrate the trainee's ability to undertake work with a diversity of people or communities,

• of varying ages across the lifespan

• with different ethnic/religious/cultural contexts

• with different individual characteristics including gender identities/sexualities

• with different levels of intellectual ability or neurodiversity

• with different clinical presentations

In the case of year-long integrated placements, trainees should ensure that the 2 clinical practice reports submitted reflect sufficiently different work (e.g. different client groups, clinical presentations and/or approach)

An essential aspect of clinical psychologists' competency is their theoretic plurality and their ability to draw from multiple psychological theories and models in undertaking their work. Taken together therefore, the 4 Clinical Practice Reports should also demonstrate a diversity of approach, reflecting the application of at least 2 different psychological models/approaches.

• At least one report should describe the trainee's use of CBT as the main therapeutic approach. For those trainees also working towards Level 2 BABCP Accreditation in CBT, 2 CPRs must describe the application of CBT.

• At least one report should describe the trainee's use of another therapeutic modality (e.g. psychoanalytic, systemic, CAT, ACT, CFT, PBS etc.  to understand the work . 

Taken together, the 4 CPR's should demonstrate the trainee's ability to apply psychological practice both directly and indirectly.

• At least two reports should describe direct work with service users/clients

• At least one report should describe indirect work with carers, staff, systems or communities. Hybrid approaches where both direct and indirect methods have been employed in a case are acceptable, but the trainee must demonstrate their ability to work indirectly with carers, professionals, organisations, or systems.

It is expected that the four CPRs completed across the programme reflect an increasing complexity of work undertaken on placement and the application of progressively well-developed clinical competencies. 

Trainees must complete a CPR log (available on Blackboard). This log should be periodically reviewed with the trainee's clinical tutor to ensure a balance of presentations and approaches.

Structure and Content

There is not a prescribed structure for the writing of clinical practice reports, however trainees should ensure their reports are organised and written in a professional style that is appropriate for a clinical psychologist operating within the frameworks of a reflective-practitioner and scientist-practitioner. There is a long history of clinical psychologists using case reports to share their ideas and practice and there are many examples of different approaches to this in the published literature.

Often trainees have found it helpful to describe their work chronologically in a way which explicitly reflects the stages of a common care pathway- assessment, formulation, intervention and evaluation- however, other approaches are acceptable and are sometimes more appropriate.

Regardless of the structure employed, attention to these and other core elements should be included within each report:

Background Information: Trainees should ensure they clearly state the reason for the referral, relevant clinical history, and other contextual factors. A brief description of the service setting should also be included.

Contracting: Trainees should ensure they describe how the work was negotiated and agreed with the client/service user, with reference to any desired outcomes, how these will be measured, and a description of how consent was gained (both for the work itself and for the case to be used as a case report).

Assessment: Trainees should describe the information they deemed to be relevant to the work and how they gathered this. Sources of information should be made clear, and attention should be given to the client's own frame of reference with consideration of any meaning or understanding the person may attach to their own experiences. An assessment of relevant risks (and mitigation plans where appropriate), which is reflective of current best practice guidance, should be included in all cases.

Formulation: This should be a central aspect of each report, reflecting the trainee's own psychological understanding of the presenting difficulty. There should be clear links with the information gathered at assessment along with reference to appropriate psychological models and theory. The person's social, cultural, and organisational context should also be considered. Where trainees are making use of model-specific formulations of presenting difficulties (e.g. a CBT formulation of anxiety), these should be included alongside a description of the trainee's own psychological understanding of the person and the longitudinal aetiology, development, and maintenance of the presenting difficulty.

Intervention: Trainees should clearly describe what, where, when, why and how they employed psychological practice in the case, in a way which enables this to be understood and replicated as closely as possible*. The approach chosen should link directly to the formulation and there should be a clear rationale for why this approach was chosen, with reference to the appropriate evidence base and practical guidance.

(*It is not necessary to include detailed descriptions of each session, a summary is sufficient. Further detail can be included as appendices if desired)

Evaluation: Trainees should consider and describe the impact of their work both quantitatively and qualitatively. This should typically involve the administration, scoring and interpretation of any appropriate measures, feedback from the service-user and other stakeholders, reference to any desired outcomes and/or functional changes and description of the trainee's own evaluation of the work.

Critique: Having completed and reflected on the work, trainees should consider what aspects of their practice were more or less successful in this case and what if anything they would have done differently in hindsight or would do differently if working with a similar case in future. Reflections should be made on the quality of the therapeutic alliance and how endings were managed. With post hoc reflections on the evidence base and practice guidance, consideration should be given to the trainee's original formulation of the presenting difficulty and the selection and implementation of the intervention strategy.

NOTE: We recognise that the work trainees complete on placement may not always involve them undertaking their own assessment, formulation, intervention and evaluation of a case. In these circumstances it is acceptable for up to 2 reports to have a more restricted focus or leaning (e.g. assessment or intervention only), so long as the trainee makes clear how this forms part of a coherent pathway which includes stages of: enquiry about the case (assessment), understanding of the presenting difficulties (formulation), a plan for how this can be helped (intervention) and how the impact of the work will be measured (evaluation). When doing this, stages not completed by the trainee may be described either as being completed by others (e.g. a prior assessment) or as recommendations for the future (e.g. a treatment plan and evaluation strategy). Regardless of the work completed, each CPR should include the trainee's own detailed and individualised formulation of the aetiology, development and maintenance of presenting difficulties.

Whilst reports should be structured about the work completed, we recommend that the trainees familiarise themselves with the clinical competencies the CPRs will be used to assess (see introduction to this section) and endeavour to demonstrate their understanding and application of these competencies within each report.

In addition to assessing trainees' clinical competence, CPRs will also be used to assess trainees' ability to synthesise their empirical competence with their personal and professional competencies as ethical-practitioners, scientist-practitioners, and reflective-practitioners.

There must be explicit reference within each report to the trainee's understanding, use and critique of relevant psychological theory, evidence base and practice guidance, either in a dedicated section of the report or interspersed throughout, and it should be clear how the trainee has drawn from and synthesised this with their own thoughts and beliefs (perhaps developed through supervision) to inform their work. Where the chosen approach differs from existing guidelines and/or the evidence base, this should be explicitly addressed, and a rationale provided.

Trainees must ensure that they demonstrate substantial consideration of issues of inequality, difference, power, privilege and disadvantage within their work, with reference to health inequality, the relevance and applicability of psychological theory and evidence to the specific client/service-user, and any adaptations relevant to their practice. Particular attention should be given to any characteristics protected under the Equality Act (2010) but wider consideration of individual and social context and other determinants of health inequality might also be included. Trainees must also reflect on their own personal context and biases and how similarities and differences between themselves and their clients (and potentially their supervisors) impact the work.

In addition to the elements described above, each CPR should ensure it meets the following requirements:

Confidentiality: The confidentiality of service-users, services and supervisors must be protected along with the identity of the trainee to ensure 'blind' marking. Care should be taken to ensure that all reasonable steps have been taken to prevent any identifiable information being included within the reports. All identifiable details in the main body of the report and appendices (e.g. letters) must be removed by hand, not be use of a computer programme. An 'Anonymity Checklist' (available on Blackboard) should be completed and included on the 2nd page of each report.

Referencing: References to models, theory, the evidence base, practical guidance or other literature must be appropriately acknowledged both within the text and in a reference section at the end of the report, employing the APA referencing style.

(NOTE: Failure to adhere to this standard will result in any mark given being conditional on the referencing style being corrected)

Appendices: Each clinical practice report should include within the appendices copies of ALL anonymised correspondence used in the case. This should normally include a letter or report sent to the client, referrer, or other agency. Clinical letters may be cut and pasted, scanned or re-typed with all potentially identifying information (including service details) removed first. The reason for any absence of a clinical letter back to the referrer must be given in the body of the report. Any questionnaires, measures, or other correspondence relating to the work, particularly any referred to within the report should be included in the appendices.

(NOTE: If diagrammatic representations of formulations are used, these should be included within the main body of the report rather than the appendices)

Focused Reflection Section

Approximately 1000 words of the assignment should be devoted to the trainee's reflections on a particular area of their learning. It is usual for this to be addressed in a separate section, but it could be integrated throughout the report if this is preferred. The details of the different areas of focus are as follows:

Process- Particular attention should be paid to the process of the clinical work. This should include interpersonal processes and their impact on the work. Where appropriate, processes involving the contextual organisation around the client should also be considered. Trainees may also want to consider processes which link to the stage of work- forming a therapeutic relationship, engagement in the work, processes around endings, etc. It is expected that recording of sessions will be carried out with clients, with their (and supervisor's) consent, to support reflections. Appendices should be dedicated to edited transcripts or summaries of audio or video recordings, which illustrate the issues referred to. Please note that full transcripts of sessions are not required, only edited extracts. In the event that a trainee is unable to get a recording in Year 1 they should aim to do this CPR in Year 2. In exceptional circumstances, and with agreement of a Clinical Tutor, it may be possible to use process notes as an alternative. Process notes are different from session notes and, in this instance, refers to a detailed account of what was said in the session (or as close to this as possible) and may include observations of behaviours, facial expressions or other non-verbal communication. This might involve taking notes in the session if you and supervisor think this is appropriate, or writing them as soon as the session finished so your memory of the conversation is as fresh as possible.

Supervision- The role of supervision should be explored in some detail. Trainees will need to keep a supervision log or diary recording the main themes discussed in supervision, the learning that took place and how this affected the client work. Trainees could consider what kind of supervision was developed in response to the demands of a particular piece of work e.g. information giving, space for reflection and containment (and whether this changed over the course of the work); or whether the model of intervention used was reflected in the nature of the supervision. Illustrative extracts from the supervision diary should be appended to the main text as an appendix. Trainees may consider drawing on a specific model of supervision. 

Personal and professional development- The focus here is on learning about oneself at work using illustrative examples from a learning and development log. Selected extracts from this log should be provided in an appendix. It may be helpful to think about whether or how the work has been challenging, for example by considering some of the issues around providing psychological help in a context of social injustice/disadvantage, and how managing that process can be a key element in working with some clients/client groups and can be personally challenging (e.g. in raising prejudices or challenging familiar narratives).

Inter-professional learning- This focus includes work with other professionals. It should consider factors leading to the success or otherwise of the joint work and reflections on how differences in terms of roles, underlying philosophies or models, etc, were integrated/reconciled. Other professionals are defined as any other staff groups including support workers but excluding psychology assistants. Inter-professional learning could take place through: speaking with staff from other disciplines; shadowing other professionals; visiting services other than clinical psychology to understand the context of the client's involvement in mental health, social care, voluntary or private sector services; joint team work, including therapeutic work; joint seminars or clinical reviews. The emphasis should be on both the trainee's learning from others and what the trainee brought to the understanding of others. Trainee awareness and response to systemic processes should also be considered under this focus with consideration of leadership roles where appropriate.

Each CPR should examine one of the areas of focus above such that all 4 areas will have been considered across the 4 CPR submissions. The reflective account should draw on examples within the work they have described in the preceding CPR but can also draw on other work they have competed and should include how they will seek to continue their development as a clinical psychologist moving forward, particularly in any areas identified as needing further development. 

Each CPR must be submitted along with a completed Front Sheet and an Anonymity Checklist (templates for each are provided on Blackboard). 

The front sheet must include the following:

1. Title- Succinct Description of the Case Report (This should be in a professional case study style)

2. Scope of the Case Report- Assessment and Intervention, Assessment Only or Intervention Only

3. Main Psychological Approach Employed- CBT, Systemic, Psychodynamic, CAT etc

4. Focus of Reflection- Process, Supervision, Personal and Professional Development, Inter-Professional Learning

5. Word Count- Total Word Count, Case Report Word Count, Reflective Focus Word Count