Clinical psychologists’ constructions of their work with children

This study adopts a discursive psychological approach to an analysis of
interviews with nine clinical psychologists on the subject of their work with
children in NHS-based Child and Adolescent Mental Health Services. The
objective of the study was to explore how child clinical psychologists talk about
their work, with a particular focus on the discursive and interactional aspects of
the discourse, and participants’ orienting to, and providing justifications for, the
morally dubious status of the various practices that they described in their talk.
The analysis delineates complex rhetorical strategies of accountability
management in talk about practices depicted as potentially problematic. These
included: (1) the ‘severe end’ rhetorical device that functioned to warrant the use
of medication; (2) the minimisation strategy that was used to manage diagnostic
problems by constructing diagnoses in a minimal or safer manner; (3)
normalisation techniques which served to downplay and re-define contested
practices as less problematic or indeed as positive; (4) doing ‘being democratic’
that constructed troubling practice as democratic; (5) employing ‘maxims of
practical politics’ that seemed to legitimise contested practices by invoking liberal
and pragmatic arguments; and (6) the discursive move of redirecting
accountability to service users or the institution. The discursive analysis of the
extended accounts also demonstrated how participants oriented to notions of the
moral nature of their practice and their morally adequate personal and
professional identities. The results of this study indicate that clinical
psychologists face a moral quandary, suggesting that perhaps clinical psychology
practice, particularly with children whose distress or behaviour is conceptualised
as mental illness, entails a constant grappling with moral issues. Implications for
clinical practice are discussed in light of the analysis.