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What is a Clinical Associate Psychologist (CAP)? & How do you train as one?

by Dr Marianne Trent, Clinical Psychologist

Welcome along to The Aspiring Psychologist Blog. This blog post is an adaptation of episode 39 of The Aspiring Psychologist Podcast.


I know from speaking with many of you that it can feel incredibly disheartening when we are coming up in the field of psychology. Perhaps people have multiple application cycles to becoming a Clinical Psychologist or even other types of psychologists. You might feel like you are getting interviews but not getting the result, not getting the job that you desire. Sometimes the feedback can be varied. It can be about performance in an interview. It can be about academic skills and resources that need strengthening. Sometimes people find that they are not even getting shortlisted for an interview.


It can be really disheartening. It can make people feel, “maybe this isn't for me. Maybe I should give up. Maybe I should do something different”.

When I was an Assistant Psychologist, it was not easy to piece things together and convince people that I would be a great Trainee Clinical Psychologist. And I think I was one; I did reasonably well at that.


I loved my assistant roles, but you might have heard there is a new kid on the block: the CAP, the Clinical Associate in Psychology. You might not know what that is or how that would work. Maybe you have heard of it but never quite remember what the initials mean. Just imagine it is a CAP that you are wearing. I thought it would be lovely to get someone along to talk to us who is themselves a CAP, and also works at university helping to train future CAPs. I invited Elise along, a qualified CAP who also works in academia training future CAPs at Plymouth university. So, with no further ado, let's get on and meet Elise and see what she and I have to say.


Marianne Trent:

Welcome along to our guest today. Elise Dyer is a clinical tutor and a lecturer on the MSC CAP programme at Plymouth uni. Hi, welcome along.


Elise Dyer:

Hi. Hi, lovely to be here and lovely to meet you. <Laugh>


Dr Marianne Trent:

You too. Thank you so much for joining us. So, for those who don't know what the CAP initials are, could you tell us a little bit about that please?


Elise Dyer:

Yeah, of course. It's a new programme.

“It's the Clinical Associate Psychologist MSC programme. Most universities in the UK are now offering this programme.”

It's a collaborative MSC apprenticeship programme. The NHS funds this programme. So, NHS services work with local universities to provide this apprenticeship programme. It takes 18 months, and apprentice CAPs train with us at Plymouth university, and they spend two or three days in their workplace learning on the job if you like. So, they get a chance to practice what they learn in their lectures.


Dr Marianne Trent:

That sounds brilliant. So great to know that such a programme exists! That you can be funded to do an MSC and also learn valuable skills and get that clinical experience at the same time.


Elise Dyer:

Absolutely, absolutely. I think it's a brilliant opportunity really for people, psychology graduates. So only psychology graduates, I'm afraid, can apply to these programmes because you are trained in clinical skills, and a psychology degree is viewed as a foundation to build on those skills. And ideally, apprentices should have a couple of years of experience in the field as well. It doesn't have to be paid experience, but it's ideal for them to have some clinical experience as well.

“The programme was developed to offer opportunities to people who cannot get onto the Clinical Psychology doctorate. As you know, it's incredibly competitive, and there are a lot of psychology graduates and experienced clinicians working in AP posts, or other posts, trying for years and years and years to get onto the doctorate, and it's just not happening.”

So, we get those people applying to Clinical Associate Psychology programmes to become a CAP because the CAP essential skills align with Clinical Psychologists skills. The core competencies are providing assessment, formulation, intervention, and consultation.


Elise Dyer:

So, competency skills to be able to work with people indirectly providing clinical skills, if you like. So, in that sense, it's quite similar to Clinical Psychologists competencies. The main difference is CAPs are semi-autonomous practitioners. So, CAPs must be supervised by a qualified Clinical Psychologist, or another applied psychologist. That has changed recently. Initially, it was a Clinical Psychologist, but it has changed now to any applied psychologist. It could be a Counselling Psychologist or any other applied psychologist in the service who can supervise the CAP. So, semi-autonomous practitioners. That's the main difference.


Dr Marianne Trent:

Thank you. So, it sounds like it's kind of a system work, but with much more structure and it's more of an applied programme.


Elise Dyer:

Absolutely. It’s more applied and more hands-on with a bit more autonomy compared to being an Assistant Psychologist, I suppose. Because CAPs again, under clinical supervision can provide a variety of tasks in a service; assessment, formulation, intervention, and run groups. Doing integrative therapies, because they're trained in a variety of therapeutic models. So, they could really provide those interventions to their clients in their specific services. So, because they are trained in a specific service, there is depth of knowledge compared to Assistant Psychologists.

“Assistant Psychologists are usually just psychology graduates, whereas CAPs have done their psychology undergrad degree and have trained in this specific 18 months programme going through a quite a robust learning process.”

Really, they have. For instance, they have 119 knowledge and skilled behaviours that they learn and then demonstrate to graduate as a CAP. So, by the time they complete the programme, they have various skills and competencies that take them a step ahead compared to other professions at AP level.


Dr Marianne Trent:

It sounds brilliant. And actually, it sounds like something I would've really liked when I was an aspiring Clinical Psychologist myself. I did feel a little bit de-skilled, you know? I felt like I didn't really have a thing. It is hard to get therapy experience when working as an assistant. I found that at the time. Things have changed a great deal since I was coming up in the field of psychology, but I really like the sound of this programme and how it trains people. And it gives people the experience of what it will be like if they do go on to do doctorate, but of course you might choose not to; you might choose to stay as a CAP because you really enjoy that.


Elise Dyer:

Absolutely. Absolutely. Again, some people, like you say, come onto the programme with a kind of long-term goal of completing this programme, working in the field for a couple of years, and then still applying for the doctorate, which is fine. It's a choice, but some people do change their minds and stay working as a CAP. The CAP programme has another difference compared to other kinds of foundational level professions.

“CAPs are trained as band five clinicians and upon qualification. They work as a band six clinician in services, however things are changing and roles are expanding in services.”

And there are opportunities for career development and applying to band seven roles as well. For instance, in Cornwall we have a colleague who, after the CAP qualifications, secured a band seven position within the NHS and is now performing that role. So, there is that option and opportunity as well.


Dr Marianne Trent:

That's really interesting and really good to know. It really does help people to earn a livable wage whilst they're training as well. So, when you're training you get the band five, but you also get your tuition fees paid as well. Is that right? Elise?


Elise Dyer:

Absolutely. Absolutely. Yes. It's all paid. Yes.


Dr Marianne Trent:

Amazing. That sounds incredible. How did it come about as a thing, as a programme, do you know much about the history of it?


Elise Dyer:

Yes. Basically, Professor Ken Laidlaw from Exeter university used to be a Clinical Psychologist lead. But if I remember right, he might be retired now or just about to. So, he was receiving feedback and observing that a lot of aspiring Clinical Psychologists are suffering. Not being able to get in onto the programme, feeling really frustrated and feeling really disappointed. And that we are losing these psychology graduates, and potentially good clinicians. So he and Mike Hutchinson, from Exeter university again, I think they started talking and looking into a training programme where we train people to work as an Associate Psychologist and train them within a shorter programme instead of three years doctorate programme, but still give them depth of knowledge to work as a good clinician in the field.

“That's how the programme started developing, really. Clinical Psychologists noticing that there's a gap in the psychology field. So, we could create clinicians that we can place between Assistant Psychologists and Clinical Psychologists. Because before CAPs, there was nothing in between if you like.”

So, that's how it was created - noticing that gap and witnessing psychological graduates not getting onto the programme and feeling utterly disappointed. So, that's how it came about.


Dr Marianne Trent:

This sounds incredible. They did a really good job there. I think I know last year it came as a bit of a shock in September, on the 1st of September, in fact. When the clearinghouse announced that there'll be HEE limits for funding. Is this programme part of that as well? The Higher Education England funding rule.


Elise Dyer:

At the moment? It is, yes. So yeah, if people are training as a CAP, yes. So, after qualification they need to be staying and working. Is it two years or three years?


Dr Marianne Trent:

I think it's two. So initially, on the 1st of September, they said it was like a blanket from then onwards, didn't they? But there'd been a lot of lobbying. And yeah, it's been, I think it's been overruled and delayed until next September to allow people a chance to adjust, you know, was that as much as of surprise to the universes as it was to us in the field as well, when they just announced that blanket ban?


Elise Dyer:

Yes. Although it was a surprise and a bit of a shock, but I personally think it's a good thing. I'm not gonna deny. I think I agree with the idea, because when you go onto a programme and when you train, you really need that consolidation time to be able to really apply your skills and learning and to feel really comfortable and confident in what you learned and how you apply that in the field in psychology. So, I think two years is a good time to be able to do that. And also, I must admit the programme, it's a brilliant programme, but it's an intense programme. It's not a breeze at all. And you know, there's a lot of assignments to get through and a lot of skills to learn and to apply in your service. So, it takes its toll, if you like, and I think jumping from one programme of tiring hard work to another three years of another intense programme… Although I haven't done the Clinical Psychology Doctorate, I have friends who have done it and who tell me similarly that it's hard work. It's, you know, it's not a walk in the park. So, jumping from CAP course to the doctorate would've been really hard.

“So, I think it's a good thing that people will be forced if you like to take that two years of breathing space and just work, forget about training for a while and just apply what you learned, consolidate that learning and yeah, perform as a clinician, if you like.”

Dr Marianne Trent:

Yeah. I don't disagree that it's not a good idea. And it certainly will make people less impulsive, you know, thinking about actually, whether this is gonna be right for them and whether that is something that they want to commit to. But I think the issue was it took away people's informed choice. Didn't it? Initially, when they said, “you can't do it for two years”. And it's like, well, that's not fair, you know?


Elise Dyer:

Yeah, you are right. And it was just like a last-minute thing that just came about. Luckily they pulled back and allowed people to apply and get onto the courses. And now hopefully people have enough knowledge to make an informed decisions from now on.


Dr Marianne Trent:

Yeah. And it was actually an aspiring psychologist himself who really spearheaded that campaign to get that overturned, Han. He did such an amazing job. He's now secured a place on training this year as well, which is incredible. It's helped so many people. Had that not happened, it's unlikely they would've changed their decision at that stage.

“So, you know, there's a little message there that if we don't agree with things, we can raise our heads and raise our hands and fight for what we believe in.”

But it's interesting to know there's assignments in there as well. Are there exams too? Elise?


Elise Dyer:

Yeah, no exams, but we have a variety of assessments and essay case reports. They also have, as I said, 119 knowledge-skilled behaviours that they have to demonstrate to their clinical supervisor in order to be signed off. And at the end of the programme, we have an endpoint assessment. So, throughout a year, they learn all these skills, knowledge, and behaviours, and at the endpoint assessment they are set a day, or two days, where they demonstrate the skills and competencies they gain from the programme in role plays.

“We have four stations; the assessment station, the risk station, the formulation station and the intervention station. So, they go through those stations and demonstrate through role play with an actor.”

They demonstrate those clinical skills live while being assessed by an independent assessor. And they get their marks as a pass or fail. So, I guess the difference for the CAP apprenticeship programme is that not only do they write the same assignments and case reports, but by the end, they have that endpoint assessment process. It can be seen as a showcase. You are actually celebrating what you are, what you gained, and you are showing off your skills. Needless to say, it also creates some anxiety in apprentices because it's live and you role-play, and no one likes role plays. <Laugh>


Dr Marianne Trent:

I actually quite like a role play Elise.


Elise Dyer:

<Laugh>.


Dr Marianne Trent:

I was an anomaly in my cohort for enjoying that. But yeah, I can imagine that on the four-station day that anxieties are certainly running high, but it sounds incredible. And you know, doing it with actors as well. I know some clinical doctorate courses that have actors come in and do things on selection days. And one time they got told off because they were wild and were almost traumatising people. So, they got told, “maybe next time don't be so much, we're not trying to scare our applicants”.


Elise Dyer:

<Laugh>


Dr Marianne Trent:

So, is it an 18-month placement that runs for the duration of the course?


Elise Dyer:

Yes. It is 18 months. Yes.


Dr Marianne Trent:

So ideally, maternity leave aside, for supervisors, you'd get the same supervisor running from start to finish. Is that ideal? Is that the gold standard?


Elise Dyer:

It's absolutely ideal and gold standard, but as you know, in services, unfortunately, that doesn't always happen. And sometimes it's unlucky a clinical supervisor may decide to stop working or get another job. And it does happen occasionally. It's not too often, but occasionally, you can get a new clinical supervisor during your 18-months programme. But ideally they would have one supervisor taking them through the programme.


Dr Marianne Trent:

That would be ideal, but I also know how busy lives and conflicting demands work. Is there a kind of mid-placement visit, or are there multiple mid-placement visits?


Elise Dyer:

We don't have visits from the university as such. I think that's the difference between Clinical Psychology doctorate programme and the CAP programme.

“So as clinical tutors, we don't visit at all, but their clinical supervisors work with them closely.”

And of course, they're embedded in their service. So, their manager, their colleagues, their MDT is, you know, keeping a close eye on apprentices and working with them in order to help them and support them to gain those skills.


Dr Marianne Trent:

Great. And are there teaching blocks at uni, or is it done a few days of the week?

Elise Dyer:

Oh, there is definitely teaching blocks when they start, they have a teaching block with university and then they go to their placement and when they start their placement, there is one or two days of uni days, but yeah, it's mainly done in teaching blocks and then service.


Dr Marianne Trent:

Great. Do you feel like I'm firing loads of questions at you?! But I find this so interesting, and I know our audience will as well. Are all the placements in adult mental health services, or are they across the lifespan? Could you tell us a bit about the nature of the placement basis, please?


Elise Dyer:

Yeah, sure. It's all depends on which services need CAPs and which service comes to the university saying, “can you please train some CAPs for us?”. But it's across the lifespan. It could be.

“So, for instance, currently, we are training adult mental health services. People CAPs will work in adult services, but we also train CAMHS clinicians.”

So, I was trained within CAMHS as a CAMHS CAP. So, we train CAMHS CAPs as well, but we also have plans for training CAPs in learning difficulties, any other secondary mental health. So it could be across the lifespan, elderly working with you know, elderly, older adults.


Dr Marianne Trent:

Brilliant. So, you'd know at the point that you were replying to the university, what the programme was and which area you might end up working in?


Elise Dyer:

Absolutely. Absolutely. In that sense, again, it's different from Clinical Psychology programme. You apply to NHS service. The best place to keep an eye on is NHS jobs, because these jobs are advertised by the NHS. So, when you look at a job, you will see which service it is, where that service is and what they offer basically. So, you could be looking at CAMHS in Cornwall is recruiting apprentice CAPs to work within CAMHS. You could be looking into an advert to work in adult services or learning difficulty services. So, if you like the sound of working and training in that particular service and area, then please do apply. But if you feel like, “mm, I'm not sure, maybe I wanna work in CAMHS services, not learning difficulties”, then you've gotta wait until a CAMHS CAPs opportunity becomes available again. That's the difference between the Clinical Psychology doctorate and CAPs, Clinical Psychology has a breadth of knowledge. You have different services, you are placed for about four to six months moving from one service to another, and it could be children's services, learning difficulties, adults, et cetera.


“Whereas CAPs training is one particular service, so have a depth of knowledge. If you're going into a learning difficulties service, you'll train in that for 18 months and you'll upon qualification, you'll work in that particular area, if you like. So, you have a depth of knowledge, not breadth.”

Dr Marianne Trent:

Okay. So, you wouldn't necessarily be able to apply for a qualified CAP role in a child service if, for example, you're trained in older adults, because it's not necessarily transferable?


Elise Dyer:

Not necessarily, but again, there are talks about how the core skills and competencies are transferable like those assessment and formulation skills and, to a certain extent, intervention skills. So, it depends on the service. No one would stop you from applying to a different service. Even though, say you are qualified as a CAP within clinical psychology, but you could go and apply to any other service saying, “well, I've got the foundation skills, I've got those transferable skills, and I'm happy to receive top-up training from you”. Maybe there could be in-house training to add those extra specific skills to be able to work in that service. So, it could happen. So, there's no hard rules about if your qualified in this then you can't apply to any other service.


Dr Marianne Trent:

Okay. That's really good to know. And when people are looking on NHS jobs, what terms should they be searching for, if they're looking for these training roles?


Elise Dyer:

They could use the search terms Apprenticeship Clinical Associate Psychology CAP. So, I think those should bring up those roles.


Dr Marianne Trent:

Great. Thank you. And I guess whilst people are trying to learn a bit more about it, they could look at doing a national search couldn't they? Then they could see who's recruiting, what they're saying, and what the person specs and the job descriptions are like. If they do wanna have an overview of what's around at the moment.


Elise Dyer:

Absolutely. Absolutely. And also, I think this is an important thing as well for people. Our programme is entirely remote teaching, online teaching.

“I believe most universities provide CAP programme as remote teaching.”

So, they will be going into their NHS placement service. So, they've gotta live nearby their service, but they don't have to live near the university. So, we are in Plymouth university in Plymouth, but we have Southern Health from the Southampton area and Oxford CAMHS training with us. We have Cornwall CAMHS training with us. So, I think online, remote teaching is really effective and helping people greatly. I think this is one of C's silver lining, isn't it? That universities now can provide those online, fully online programmes.


Dr Marianne Trent:

Absolutely. And it's all about improving accessibility for people and being able to fit it around their lives. You know, I'm a mother myself, and I know you are too, and it just helps you to be a bit more flexible.


Elise Dyer:

Absolutely. Absolutely. Yes.


Dr Marianne Trent:

I understand you were part of the second cohort where you trained. Could you tell us a little bit about whether you enjoyed training, how you found it and all of that?


Elise Dyer:

Absolutely. Yeah. I was the second cohort in Cornwall and in fact, I was working as a primary mental health worker within CAMHS part-time. I was highly interested when this opportunity became available, so I applied, secured the position, and thoroughly enjoyed training. It wasn't an apprenticeship when I did it. It was just a degree. So, I trained within CAMHS, and I knew the service. I knew the people I worked with. So, I was already embedded in the team, which was quite helpful actually. And the training was really good. Lecturers came from Exeter university; it was Exeter university to Cornwall to train us. Back then, it was face-to-face and in my cohort there were 26 of us, and we were all highly motivated and bonded well.

“It was a really good experience, really hard work. As I said earlier, it wasn't a breeze. So, you know, you've gotta be well organised and highly motivated.”

And you've gotta be on top of it, I guess, to be able to keep up with it. But, it was all a good experience, I would do it again and again. So, it's a lovely experience.


Dr Marianne Trent:

I'm quite tempted actually Elise <laugh>. I've been qualified as a psychologist since 2011. Do you get much of a chance to do cohort bonding these days when it is online only, cause you might be the only associate training CAP in your service. Are you getting much time to do any cohort bonding?


Elise Dyer:

Yeah. Good question. We have hybrid days, basically we ask our apprentices to go into their service from their locality in fives or sixes. So, they have hybrid learning days where they learn together, and we provide them tasks on those days where they do it together. So, then there's a bit of bonding as well. And most of our cohorts, what they do, they all create their own cohort WhatsApp, and then they always text each other and talk and liaise and help each other and support each other. So, there is. Even though it may sound like its all remote, and they may not bond, they actually find ways to bond.


Dr Marianne Trent:

Good. I'm so pleased to hear it.

“When I was training as a Clinical Psychologist, and even when I was an Assistant Psychologist, one of my favourite bits of those roles was the relationships I made with people doing the same thing at the same time.”

So, it's really important. And when we are trying to avoid burnout on the way up it's really important to have peer support. Yeah. I love to be a fly on the wall in those WhatsApp groups. <laugh>


Elise Dyer:

Same here. <Laugh>


Dr Marianne Trent:

Could you give us some of your top tips for avoiding burnout on the way up and through psychology careers? If that's okay.


Elise Dyer:

Absolutely. I guess we've gotta practise what we preach as psychologists. Really having a good work life balance and making sure your boundaries. I love this word - boundaries.

“So, if your working hours are nine to five, please do stop at five, turn off your work laptop and do not check your work emails. Really look after yourself, have a bit of me time at weekends, spend quality time with your family and friends, go and do your hobbies.”

It could be as simple as just going for a walk and having fresh air, or coffee and cake, just have those little treats and simple pleasures in life to keep you going, if you like. I'm lucky I live in Cornwall. So, I swim regularly, especially these days. It's just a godsend after work. I just go and jump in the sea <laugh>. So, really claiming those me-times times back and making sure that you look after yourself. Being organised does help with that, kind of keeping a notebook. Try giving yourself time for a bit of reading between this time and that time, but then from 7:00 PM to 8:00 PM, have dinner with your partner, or watch a bit off Netflix. I dunno, I'm going to bed at such time and definitely not thinking about work or anything, really. Being strict in a way that you switch off at weekends and between working hours. I think it's hugely important.


Dr Marianne Trent:

Really, really important. Yeah, compartmentalising it. Whoever we think we're serving when we're working longer hours, we're often not. Boundaries are really, really important. I love the sound of you being able to dive into the sea. I live in the middle of England, so I’m jealous of that. That sounds incredible.


Elise Dyer:

No, really good. I'm lucky. We are lucky in Cornwall. It's lovely. All move down!


Dr Marianne Trent:

<Laugh> I might do. I might do. I might look into it. <Laugh> It's been such a pleasure talking to you and learning more about this incredible training scheme. Thank you so much for your time. I know people will be super, super interested to learn more about it. Cause it feels like this sort of mysterious newcomer.


Elise Dyer:

Yes, yes. Yeah, no, it's been lovely talking to you too. And I hope it does help some people to make decisions and choices.

“I highly recommend psychology graduates or people who need an alternative career to Clinical Psychology if you like.”

So, yeah. And do you contact me if you have any further questions or if anyone wants to know anything further. I'm happy to respond and reply as much as possible.


Dr Marianne Trent:

Brilliant. Make sure I pop your details in the show notes. Do you want people to start following Plymouth University on socials? Is that a good thing to do?


Elise Dyer:

Oh, it's an excellent thing to do.

“It's one of the best universities.”

I'm not saying this because I work for them <laugh>. It really is a brilliant programme and a lovely university really. And we are a really good team. We are happy to help.


Dr Marianne Trent:

Brilliant. I'll make sure we get the links for following Plymouth Uni in the show notes as well. And tag you when this episode is coming out, I've adored today. I could talk to you more and more, especially about Cornwall. That sounds incredible. <Laugh> Thank you so much for your time today.


Elise Dyer:

Oh, you are most welcome. Really enjoyed it too. Yeah. Thank you. Brilliant.


Elise wanted me to add that once qualified as a CAP you don't have to work for the NHS. You can also work in academia. You can also work in universities, which is what she has done as well!


Thank you for reading through this interview. What an absolute pleasure speaking to Elise was, and how good does Cornwall and the sea sound? We recorded this on a super-hot day in August. We were both melting, which is why we decided, I decided, to go off camera today and just do audio. By the time we started filming, I'd not long got back from a run and got out of the shower, and I was just so hot. So I thought, “Let's just keep it on audio”. I hope that hasn’t altered your enjoyment if you enjoy watching on YouTube.


I hope that this has been really useful. How incredible does the CAP sound? I would love your thoughts on this blog post. If you want to come and join us for free on Facebook in The Aspiring Psychologist Community with Dr. Marianne Trent. Come and discuss what you thought of this, I'd love to know what you are thinking! Has it inspired you? Has it given you some more information? Or if you would like to join the waiting list for the next time The Aspiring Psychologist Membership opens, please sign up!

If you've got any ideas for future podcast episodes, then feel free to connect with me on socials and let me know! You can also find the dates for the upcoming compassionate Q&As to support the DClinPsy application season on my socials. They are totally free to attend! If you want to join the free Facebook group, the Q&As will definitely be available there. So come along and join us so that we are nice and ready for when they start in September 2022.


Again, thank you for reading and for being a part of my world!


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