Uncertainty Work as Ontological Negotiation: Adjudicating Access to Therapy in Clinical Psychology

Across the UK, wide-ranging efforts have been made to enhance citizen access to psychological therapy. Clinical psychologists are key providers of and gatekeepers for therapy.

This paper is concerned with how clinical psychologists foster access (or not) to psychological care. More specifically, it interrogates how psychologists manage, and make decisions around, patient referrals. Following a referral, psychologists must resolve an uncertain situation: should they accept a referral and continue with an assessment? Thereafter, they must make a decision about whether a patient is suitable for their service – and for therapy more generally.

Certainty is synthesised against a backdrop of sometimes powerful pressures to meet service targets. Taking cues from medical sociology and science and technology studies (STS), this paper interrogates some of the uncertainties around access to psychological therapy, and how (accounts of) decisions made by clinical psychologists involve negotiations of patient, service, and professional ontologies. To do so, I draw on 40 interviews with psychologists across England and Scotland.

I spotlight a kind of mental health practitioner that is often absent from or only dimly lit within sociological observation and analysis; i.e., the clinical psychologist. Through attending to clinical psychology, I extend conversations about uncertainty through a distinctive case study.