Careers in Psychology Project - 2018

I would like to Thank Beth Harcourt, who is an undergraduate student at Newcastle University studying an Honours Degree in Psychology.

Beth contacted me, during her work placement year.  She was interested in professional training and asked to interview me about my career as a Chartered and Registered Clinical Psychologist.

This was an enjoyable collaboration in which we both aimed to discuss questions that may be of interest and benefit to aspiring students.  

Here is what we talked about -

Could you outline your career path into Clinical Psychology?

I heard a talk by David Smail, when I was on my undergraduate psychology degree at Nottingham. He was an inspiration and his book ‘Taking care’ was gentle, when many approaches seemed harsher and dehumanising.

He asked our seminar group to put our hand up, if we wanted to be a Clinical Psychologist in the future and many did. He then said ‘well out of this room full of hands, only one of you is likely to get there, due to the demand versus supply for places’. There was 1 place for every 400 applicants when I applied and sadly it’s probably a higher ratio now. A sombre thought.

I spent a few years in London, exploring life, then I decided to commit to becoming a Clinical Psychologist, with thoughts of how to effectively help people to heal, still in my mind.

I later found out that doing a relevant PhD first, was a better way to get on training courses at the time, as I was told that courses liked people with research skills. Also working as a Research Assistant or a Psychology Assistant close to a Training Department or within a Centre of excellence seemed to help the odds in your favour.

But that was not my route. I had caring values and started at the coal face, working three jobs from 5am shift to 11.30pm shift 7 days a week.

I started my career journey as a Care Assistant and I learned a lot about the lives of people with learning disabilities, in residential care and the teams that try to help them. 

It took quite few Care Assistant, Nursing Assistant, OT Assistant jobs to get my first Assistant Psychologist job.

I would also read the British Psychological Society appointments memorandum as it was then called and I’d apply for Assistant Psychology posts that I hoped I had relevant experience for.

Luckily, I got a job as an Assistant Psychologist in a Learning disability community Team in North Yorkshire and I was fortunate to be amongst an innovative bunch of people who had fabulously humane values and wanted to help oppressed people to have rights, when they had traditionally been disempowered.

We developed sexual education groups and access to supported employment programmes, for people with Learning disabilities and did approaches such as ‘gentle teaching’ to help people with challenging behaviour. It was cutting edge stuff back then.

The Assistant job also involved following the snow plough thirty miles across the North Yorkshire moors in heavy snow, which was hair raising to say the least, but it was a beautiful place to live and very rewarding.

It took another Assistant Psychologist job in Bristol in both older adult care and mental health rehabilitation and also a voluntary job as the National Graduate Psychologist Group Conference organiser before I obtained a training place.

Reference

David Smail. Taking care. An alternative to therapy. 1987. Karnac Books Ltd.

John J. McGee. Gentle Teaching: A non - aversive approach for helping persons with mental retardation. 1987. Human sciences press.

Are there any specific skills or personal attributes that you find are pivotal to your role as a Clinical Psychologist?

In terms of pivotal skills that are central to my current role as a Therapist, I am usually finding ways to listen effectively to what has brought the client to therapy. Then my aim is to help them to get from where they are currently stuck to where they want to be.

That journey can involve many roadblocks and twists and turns along the way, so I am trying to help them with the terrain and to have a map and a guide until they find their feet. Hopefully this is on new, but solid ground.

There are a huge range of technical skills that I’ve developed on different courses over the years – most of these were after my core training was finished and they provide a toolkit of skills to share selectively with specific clients.

To help clients, I try to bring a combination of supportive relationship skills, formulative (map building) and change making skills to share validated, outcome led therapies.

My skill building and professional learning is always on-going as new ideas and approaches of value become tested and useful.

In terms of personal qualities as a Psychotherapist I find – creativity, resilience and flexibility to be important. This helps me to adapt to the interactional style of the client to enabled them to take steps to help themselves in their lives.

I also find a kind, down to earth style has evolved. Clients sometimes become skilled in pushing people away or hurting themselves, due to their trauma histories and their own inner coping mechanisms. So,  knowing when to begin, pause and end is important.

I am a trained teacher of adults and the skills to plan and pace learning programmes, are valuable in psycho - education.

An ability to wear different hats as a Director, Overseer of safe practices, Auditor, Creative improver, Trainer, Supervisor and Therapist, to name but a few of my roles, is also handy.

Wisdom to steer clear of aspects of our industry that do not work to the same quality standards that I value is also vital - sadly money and pressures to survive corrupts some helping systems.

What do you believe strengthened your application to the Clinical Psychology Doctorate?

It’s a long time ago since I applied for Clinical Psychology training and I don’t remember what I put on the form. I can best speak in general terms based on what I've noticed since then.

I think successful applicants stand out based on how clearly and relevantly they present their application forms (bearing in mind the course will have to look through thousands).

In creative writing there is a term ‘show don’t tell’. In this context, this means that the Applicant has presented their relevant experiences by ‘showing’ succinct, but clear detail of how they have gained a skill or experience. This is different from giving a list of what you can do without any evidence to back this up.

It involves being realistic in your understanding of your stage of career development. Courses easily see through over inflated or over generalised claims of what you can do or ideas that don’t fit with the job area showing a lack of understanding. So, show openness to learn, diplomacy and honesty as well as good presentation skills.

Think carefully about the reasons why you think you can offer the course and career area something useful. That’s different to saying what you want from them. There will hopefully be time later, if you are successful, to discern if that particular course has enough to offer you.

Terms which imply you are going into a profession to ‘help people’ or because your family have suffered from various psychological conditions, should be carefully thought through, so that you show balanced coping and interpersonal functioning that could manage the demands of the course.

Going onto a course because you want to rescue your parent from their depression or to resolve your own trauma, shows you are unlikely to fully understand what the course is about or be ready to train.

So, it’s probably a safer approach to explain your own disability and adversity for the strengths and understanding you have gained from it, if this is part of your reason for applying.

How has your experience of working within the NHS compared to that within the private sector?

Many people do not realise that improving  access to psychological therapies (IAPTS) services are often provided by private companies, who then see NHS patients. So, the separation is not as clear cut as first appears.

I have had similar roles and tasks in both sectors. The autonomy I have in a private setting is greater, but the responsibility is also higher, as I make the service work, and the wages don’t miraculously appear each month if I don’t succeed.  This said ethics and good values always over rides money in my book. 

So, in some ways the NHS appeared more secure and has pensions and perks that have to be fought for in private settings.  

I am closer to the business side of things in private practice. Being able to negotiate contracts and remain competitive in an increasingly challenging marketplace is important.

In private settings I work longer hours than I ever have and most of those hours are unpaid, which worsens as the marketplace saturated with cheaper, but less qualified practitioners.

Private work can be tough in the early years and is not easy, but with experience, I have come to feel confident that our service is valued and both organisational referrals as well as self funding clients are on-going, after twelve years of being an independent provider.

I am grateful for having been able to work with such brave and marvellous clients in both settings.

In my early NHS career, I have worked in some cohesive, innovative teams. I have also worked in depleted unsupportive teams that have been dangerous to the soul.

Working for a private company, I still work with teams of colleagues, but usually more remotely via email or phone calls. I have good relationships with colleagues, and I enjoy private working more than my later years in the NHS, when I felt concerned about some of the changes in the NHS and its impact on the most vulnerable service users.

I have no regrets about leaving my Consultant Lead role in the NHS, but would not wish to be starting out again in private work.

What do you find to be particularly challenging aspect of being a Clinical Psychologist?

We don't as a profession have all the answers into the complexities of being human and how to help all people to heal. At my stage of career, I feel lucky to be able to help people find a way forward ‘often', but I can't help everyone. Failing to help can be tough at times. So, don't go into this work if you want an easy job, as change can be hard for people.

I think the wider area that I find challenging has been the way politics and trends in service provision can make it harder for people to access psychological therapies. It’s difficult knowing you could help someone more fully, but the person needs longer than their session quota. Or some people need help but can’t afford to attend. I try to signpost people to suitable sources of help if they are financially unable to afford private treatment here, but this is challenging, especially when alternative, free at source services, are depleted or absent.

That said, many people who can afford to attend, can and do work well within a defined block of work. A finite structure for sessions can be containing and helpful. Squeezing the session numbers too tightly though can be counter productive and unsupported by outcomes research.

Work life balance can be a challenge at times. I am a carer and have been since 2000 now. This has intensified over the years. I also manage a chronic illness. This combined with the working day, needs on-going planning and thoughtful reflection, so that I make sure I am energised and physically and emotionally ready for work.

Work is by far the easier, compared to being a carer or a person with a hidden disability. Though being a professional, a carer and a patient has helped me to appreciate the patient journey of others from different viewpoints and with greater empathy and knowledge.

Are there any individuals within the psychological field that inspire you and/or your work?

In my early career I read Conjoint Family Therapy by Virginia Satir, who is a renowned Family Therapist. I remember being enthralled by how she spoke about the way people related together; almost like an interpersonal dance. It impressed me the way she really understood human interaction.

As my career progressed I met some inspiring colleagues. Dr John Travis was a very well read Clinical Psychologist and a great Service Lead, who inspired our NHS Team in the 1990's.  He introduced me to Guidano and Liotti's work and that of Safran and Segal. Their work was about understanding the interpersonal ‘pull’ from the client in therapy and how to work using the therapeutic alliance with clients. This was to help them if they were stuck in unhelpful interpersonal patterns that no longer serve them well.

I learned a lot around that time about kindness and balance from my wonderful colleague Dr Pauline Johnson, who walked through life with mindful acceptance and serenity before the terms were even written about.

Currently, I am greatly interested in how our minds and bodies work together and find neuropsychology ideas discussed by a range of authors really interesting. I am thinking of Dan Siegel and Stephen Porges work. These pioneers are talking about how body's and minds are not separate and our brain and emotions matter in relation to client symptoms and therapeutic change.

I am always interested in advancements in therapy that may benefit my clients and have explored and put through their paces new protocols in EMDR and a range of third wave cognitive therapy approaches over the last decade.

Authors in these fields include John Marr (2017) who has done some pioneering work using EMDR to help people with intractable OCD.

Bob McVicar and Marielle Liebling have also been helping to bring CBASP training to Yorkshire. CBASP (McCullough, 1999) stands for cognitive behavioural analysis system for psychotherapy and is an approach which has shown promising outcomes with helping people who have chronic depression.

References

Satir Virginia. Conjoined Family Therapy. 1964, 1967. 1993 (Third Edition). Science and Behavior Books.

Guidano, V. F.; Liotti, G. Cognitive Processes and Emotional Disorders: A Structural Approach to Psychotherapy. 1983. The Guilford Press, New York, New York, U.S.A.

Safran, J. D. and Segal, Z. V. Interpersonal process in Cognitive Therapy. 1990. New York – Basic Books.

Siegel. D. J. The Developing Mind, Second Edition: How Relationships and the Brain Interact to Shape Who We Are 2nd Edition. 2012. The Guilford press.

Porges, S. W. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. 2011. Norton Series on Interpersonal Neurobiology.

McCullough, Jim. Treatment for Chronic Depression. Cognitive Behavioural Analysis System of Psychotherapy (CBASP). 1999. Guilford press.

Are there any pieces of advice would you give to aspiring Clinical Psychologists?

Think very carefully about what you seek.  Identify as best you can the roles and tasks that you love and thrive upon. Such as being a good listener or organising and planning or researching new information. We work for a significant part of our lives, so choose wisely.

Remember it’s a lot of time to invest in training. The doctorate courses are just a beginning, to further and on-going training, so make sure you enjoy the core elements and enjoy learning in this area.

There are many jobs that provide a route to a stable career, with potential for a reasonable salary and a good future in the human field.

Clinical Psychology is a relatively tiny profession and the government has recently subsumed previously ring fenced Clinical Psychology training budgets under the wider Nursing budget. So, my concern is that it could soon face extinction as a profession.

In my experience, colleagues from bigger professions such as Nursing, which have more collective voice are more likely to survive the changes being experienced in the NHS. They may also have easier routes to promotion if that is one of your goals.

That is not to say as a profession Clinical Psychology is not valuable. It is a special profession and the ways of working which it brings are rich and comprehensive, but we are in an era where quality in the NHS (1990) white paper, has been replaced by cost cutting and efficiency (2006).

Efficiency is important, but not at the expense of effective quality services.

If you can appreciate these wider issues and still want to risk pursuing Clinical Psychology in this climate of change, then go for it, but be informed about the context.

References -

Quality in the NHS white paper. 1990.