You’re not in Kansas anymore…

As a psychologist in training you learn from other psychologists who deliver your coursework, assess you and/or supervise your placements. Most of the psychologists who trained me worked in the private sector or in clinical research settings. And most of my placement experiences were alongside other psychologists in the private sector. This meant I learned a lot of valuable things about how to be a psychologist, what we do, and why we do it. What I didn’t learn so much about was how we do all of this within the broader system…

There’s nothing quite like stepping out from the environment of a psychologist in training and into the broader mental health system for the first time.  It’s a Dorothy and Toto moment – you are definitely not in Kansas anymore! There are a dizzying array of professions, services, settings and interventions to work with. You begin to truly appreciate what is unique about the way psychology teaches you to think about and approach things. And, you have to figure out how to navigate all the policies, procedures and systems both as representative of your profession and of your clients. It’s hard work!

Reflecting back now on my training – all those times the various ethical guidelines were hammered home, how every situation became an exercise in critical thinking and how I began to suspect I’d be talking about collaborative evidence-based practice in my sleep, I finally get it. It may have seemed dry, repetitive and even unnecessary at times, but all that groundwork was crucial. Why? Well psychology training can be a bit of an echo chamber. It has to be, without that immersion in your profession you can’t get a strong sense of what it is we do and why. But, once you get Out There and realise how different things are it can be a bit of a shock. You may well find yourself in situations where the way you have always operated and your perspectives doesn’t fit with the broader system or other disciplines.  And that’s okay. You just have to try to figure out where to adapt and when to hold your ground and be able to argue your case either way. And it’s because of all that ground work you did as a student, that you can do this.

Keeping it real…learning to make those calls in the bigger system can be terrifying. You will make mistakes, step on toes, and sometimes it just won’t work. At the same time though, that messiness is how you learn and bring about change if you’re willing.  You might even surprise yourself in the process, I certainly have. Only this week I put forward an alternate formulation to a senior clinician, backing my own clinical reasoning and evidence.  Later, another clinician took me to the side to tell me I’d made a good call and that this ability to assert my case and trust my judgement, even when it differed from my seniors, was a real strength of mine. It was bemusing to realise this skill that I was being recognised for was not one I’d possessed at the start of this year and was probably something I would not have predicted I’d have developed by now. So believe me when I say, anything is possible!

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The Transition from PhD Student to Psychologist

Ever wondered what it’s like for to make the transition from PhD student to psychologist? Read on!

What’s it like adjusting to full-time work?

It’s a walk in the park. Across the years of completing my PhD I was regularly clocking in a lot more than a 40 hour work week. Now, I have weekends. My evenings are free from administrative tasks, assignments, emails and extra work. I physically can’t bring my work home with me. It’s amazing! I have so much more time and brain space now. I’m even learning to play the guitar, something I’ve wanted to do for almost a decade but just could never fit in with all the other things I was juggling.

What’s it like getting back into doing therapy?

The gap between the final placement and first job plays on the minds of many a psychologist in training. Why? Well in any post-grad psych degree you juggle coursework, placement and a thesis. Once they’re all passed, you can register as a psychologist and look for a job. However, for many Clinical PhD students there can be a gap of around a year between finishing placements and seeking registration because completing the thesis takes up a lot of time. Many students therefore worry that their therapy skills may become rusty from lack of use and/or that they will be less marketable to potential employers.

From my perspective, I had a gap of about a year between placement and my job search and it did not deter potential employers in the slightest. The transition into getting back into doing therapy again was also so anticlimactic that it was ridiculous. It was just like riding a bike again. Well, what I assume that would be like if I’d ever properly mastered bike riding to being with ;).

What’s it like no longer being a student?

I’m finding that this last aspect of transition takes the most getting used to, and perhaps not for the reasons that you would expect. On a trivial level, I can now officially identify as ‘psychologist’ rather than ‘trainee psychologist.’ It saves time when writing case notes and is a much more readily understandable job! If I had a dollar for every time I had to clarify what being a trainee psychologist meant…

On a less trivial note, the hierarchy I operate in now is different. I have more peers than superiors and my colleagues regularly look to me for insights due to my training or specialty. This stands at odds to the distinct hierarchy of academic research within which I’ve spent the bulk of the last decade! I’m also far less likely to be surrounded by other psychologists now than in the clinics I’ve worked in on placements.

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The ideas that guide me

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Psychology is all about variety. There are a variety of techniques, orientations and formats. Every psychologist also has their own style or way of approaching therapy. My own personal style is probably closest to”person-centred.” I thought it might be interesting to record what my current guiding rules and philosophies are that fit under this broad umbrella, so I can look back and see whether they have changed or developed as time passes. So without further ado, here are the personal “rules” I try to follow as a psychologist:

  • Competence. People are incredibly resilient and just waiting to surprise you with their strength and capabilities if you will only let them. Always let them.
  • Expertise. The psychologist and the client are experts. Work together with the client. Acknowledge that you do not know everything.
  • ‘Crazy’ is just a construct. Not one I believe in, nor one that I find helpful. Every behaviour serves a function. The question is whether the behaviour still serves a function now and if it’s negatively impacting the client and/or the people around them.
  • Feedback. Essential. Ongoing. From psychologist to client and client to psychologist; from psychologist to supervisor and supervisor to psychologist. Should cover everything from what is and isn’t working, to where things are headed next.
  • Individualised. Evidence based practice is important but needs to be applied and adapted to suit the individual.
  • Alliance. Again and again science tells us that the relationship between the client and psychologist is important to therapy outcome. Respect that. Work on it.
  • Keep it real. Few paths in life follow a straight line. Therapy is not easy. No one is perfect. Always be yourself. Applicable to the psychologist and the client.
  • Know thyself. Therapy does not happen in a vacuum. As a psychologist, be aware of how your practice is affecting you and respond appropriately.
  • Walk with, not for. The job of a psychologist is to walk alongside the client, to assist them in identifying possible choices  and consequences, to make and review changes, to learn alternate strategies and better understand themselves. Walking alongside someone in this journey is a privilege, one that can be both rewarding and challenging.

These are the principles that I think guide me now. It’d be fair to say that there’s a fair bit of overlap between how I try to approach therapy and how I go about everyday life. Trying to piece together whether these values and ideas originated prior to, during or after my training is a bit like trying to decide what came first, the chicken or the egg? And that’s probably not a bad thing. As Oscar Wilde said, “be yourself, everyone else is already taken.” As it was drummed into me really early on in my training, you the person and you the psychologist should be quite similar.

Are these “rules” surprising to you? Different from yours?

 

 

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What to Wear: The Psychologist Edition

And now for something a bit more lighthearted.  What the heck do you wear to work as a psychologist?!

“The Rules”

There’s no straight forward answer to that question. Generally speaking, the dress code for a psychologist is ‘smart casual.’ Just how smart or casual you can be and how much personality you show varies a lot though. I’ve seen everything from child therapy conducted in stilettos, quite successfully I might add; through to jeans and sneakers, tattoos and, blue hair (though not all at the same time).

Given this diversity, ‘getting it right’ for your first placement or job can be tricky. My  plan of attack over the years has been to suss out what the general consensus of smart casual seems to be at the workplace in question and then to consider what I’ll need to be able to do comfortably in those clothes. E.g. Will I need to run or walk around a lot? Sit on the floor? Work in a prison? Visit the courts?

My ‘uniform’

One of my friends dubs my work attire “modest professional.” I think that’s a pretty accurate label. I don’t wear anything low-cut, clingy or more than a centimetre or two above the knee. As someone who looks younger than their years I also tend to err on the smarter/dressier side of things. Usually, I’ll wear a (loose-ish) pencil skirt, a patterned circle skirt or trousers paired with a nice blouse or top with sleeves. In the winter I might pair the outfit with tights and/or a cardi. My personality comes out more in the colours and patterns I wear, I am not afraid of colour! However, some accessories with more personality or that give a bit of a nod to my cultural background, I leave for weekend wear.

Sometimes having a bit more of your personality in your clothes can be an asset.  For example, it can make you seem less scary to kids if you’re sporting batman cuff-links or star wars earrings. At the same time you don’t want what you wear to detract from your work, it’s all about the client, not you after all! In my case, presenting an ever so slightly watered down version of myself at work has just become a a habit. I think because I’ve repeatedly worked in settings where a lot of clothing items or accessories posed sensory issues or a safety risk. It’ll be interesting to see if this changes at some point.

Over the past few weeks I’ve been trying to throw together a bit of a capsule wardobe for my first job. Being on a shoe string budget and traditionally finding it quite hard to find  clothes that fit well has made the process that bit more challenging. Then add my preference for clothes that are not too clingy, short or low-cut… and I’m sure you imagine the ‘fun’ I’ve had! It’s moments like these that make me seriously contemplate learning to make my own clothes. It’s involved a fair bit of bargain hunting and creativity with what’s left of the clothes that got me through five years of post-grad and four placements! But I’m more or less set now with clothes, phew!

At the end of the day, does it really matter what you wear?

Well yes and no. Beyond meeting a basic standard of professionalism, what you wear is not a big deal in the grand scheme of things. However, what you wear as psychologist can also be part of your therapeutic toolkit. Got a particularly challenging day ahead? You might choose to wear something that lifts your spirits. Doing schema therapy later on? Many psychs have a ‘healthy adult outfit’ to help put them in the right frame of mind for difficult chair work or imagery. Or perhaps you are working with a shy teen who likes Harry Potter, then why not roll out your Hedwig earrings for the day as a potential ice-breaker?

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Leaving limbo land

I have been living in limbo these past few months…

As soon as I submitted my thesis, I applied for a part-time job in the public sector. This job, a therapeutic role in adult mental health, would help me build up my clinical decision making skills, pursue endorsement and ultimately  work towards entering private practice. At about the same time, a friend of mine name dropped me to another service who had mentioned they were looking to hire someone. As a result, after submitting my CV, I was offered some intermittent therapy work with children in the new year. I was still waiting for my registration paperwork to come through though and to hear back about the outcome of my other application, so we agreed I would check in with them again in January.

Weeks passed. I found out I had been accepted for a panel interview with three psychologists for the public sector job. I was ecstatic! At the interview, I was given fifteen minutes to read through a series of interview questions and make notes. As a veteran public speaker used to responding off the cuff, this felt like a luxury! And, the questions they asked me were nowhere near as tricky as the ones I’d predicted they would ask. Better still, in contrast to the panel I sat before to gain entry into my postgraduate program, they were welcoming and supportive. I walked out feeling like the interview had gone well.

More weeks passed without news. Soon it was almost Christmas and I was nervous. I’d been told I’d be notified by this point. Out of the blue, I was also offered a part-time job, for one or two days a week doing disability assessments. I couldn’t believe it. It was the type of clinical job that 17 year old me had always planned for myself and I hadn’t even applied for it. Have you ever heard the like of it in your life?!

Receiving this new job was simultaneously wonderful and stressful. I had a lot of weighing up to do. Did I take the job outright or wait to hear back about the public sector job application? Was I willing to risk having to turn down the public sector job if it were later offered to me because the assessment job had specific days that might well clash?  And, what was the likelihood of me finding other part-time therapeutic work with adults to fit around the assessment role if the part-time public sector job fell through? AAAAH!!

After a lot of angst, I was honest with the assessment employee and they were unbelievably kind and accommodating to me. They allowed me to wait and see what the outcome of the public sector job was to figure out how I might be able to make both roles work round each other.

And so I waited, and waited and waited. And I hated it, mostly because it did not sit well with me leaving two other potential employees twiddling their thumbs. I also hated the uncertainty of it all. What if the days in the public sector job were incompatible? What if that job ended up being full-time and nor part time (as was beginning to look likely at one point)? When would they tell me what was going on either way?!

Right before Christmas, I received some information. I finally knew I was in the running, but, because the range of the available roles were caught up in HR, they weren’t sure what they could offer me. So I had to wait. Again.

And so more weeks passed. Before I got The Phone Call and was offered a part-time role in adult mental health.  I remember saying aloud to myself after the call. “That actually just happened!” I just couldn’t believe it. Stranger still, the role was within a team I had previously been involved in. Talk about coming full circle! I accepted the job with the assurance there was some flexibility with days but I still had to wait several days to confirm that the role would fit beautifully round the assessment job. The relief was palpable.

And so now I am leaving limbo land behind. I am no longer routinely checking all my job alerts and job search engines. I’ve politely declined the child therapy opportunity. I have a firm idea of what I will be doing professionally this year. And I even have a start date! I am so very grateful.

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A dream without a plan..

According to Oscar Wilde, a dream without a plan is just a wish. I wholeheartedly agree. It’s important to dream, but if you don’t think about how you’re going to make those dreams a reality, then they usually remain nothing more than a dream. As mentioned previously, one of my dreams is pursuing work in private practice, doing a combination of therapy and assessment work.

Why private practice?

Simplistically, it’s all about the autonomy and flexibility.  First, as a private practitioner you have a lot of say in what type of work you take on. You can therefore choose how you will balance out your case load and whether to specialise or diversify. Second, you also have a lot of input in the running of the practice. This allows for flexibility in your working hours, environment and fee structure.

So why not dive straight in?

You have to walk before you can run

Despite the perks, private practice is typically not the first port of call for an early career psychologist. With all that autonomy also comes a lot of responsibility. I’m not even going to go into the need to manage your own business. Instead, I’ll focus on the flip side of autonomy: isolation.

In private practice you rarely have the benefit of a multidisciplinary team. In fact, you may be a solo practitioner, operating entirely on your own without colleagues onsite to seek informal supervision from.

Supervision is a requirement for all psychologists.  It involves regularly meeting with other psychologists of equivalent or greater seniority to review (de-identified) cases, discuss therapeutic techniques, assessment approaches, updated research and ethical dilemmas etc. The idea behind supervision is to make sure psychologists remain current with best practice and to prevent burn-out. Supervision may happen informally, e.g. dropping in on a colleague for a quick chat or, formally, as regularly scheduled meetings for ongoing professional development.

Well-developed clinical decision making skills are also essential to all psychologists, but perhaps more so to psychologists in private practice who must manage risk and complexity without the benefit of informal supervision and collaboration which are more common to public sector work places.

Clinical decision making skills allow psychologists  to confidently and competently manage the complexities of providing therapy to clients at risk of harm to or from, themselves or other people; clients with multiple presenting issues (fairly common); clients presenting with less common or particularly complex difficulties and any ethically tricky situations that may arise.

Psychologists in the public sector environments typically work in multidisciplinary teams. So, ensuring clients’ safety and care is more of a collaborative process and there are generally more opportunities for informal supervision. This creates a fantastic environment for early career psychologists (graduates with up to five years experience as practicing psychologists) to hone their clinical decision making skills. This is the very reason why so many early career psychologists seek work in the public sector. Some will stay in the public sector their whole careers while others will choose to eventually move into part-time or full-time work in private practice.

The issue of endorsement

Many psychologists in private practice also have an area of endorsement. This means they’ve gone on to do further supervision to really hone their skills in a particular area e.g. clinical psychology, educational and developmental psychology or health psychology etc. This involves quite an intensive process of supervision, day to day practice as a psychologist and professional development that also assists in developing those clinical decision making skills.

Because endorsement takes a further one to years of on-the-job training beyond the years of study to register for a psychologist, it’s something a lot of early career psychologists (people with up to five years of experience working in the field) lack, at least initially. This can happen for a number of reasons. The person may not be eligible to seek an endorsement (there are specific requirements). The training can be tricky to set-up depending on your location and the availability of qualified supervisors  (you need a specially trained and endorsed psychologist to supervise you in my country). Finally, if you are in the private sector, or, in the public sector but without access to an endorsement program, you may have to source one of the aforementioned supervisors externally and/or pay for their supervision.

What’s my plan?

Build up my clinical decision-making skills

  • Seize opportunities to provide therapy to people with common and  complex challenges in a supportive multidisciplinary environment.

    Spoiler alert #1: I think I’ve found myself a bit of a ‘unicorn’ of a first job in just such an environment. Lots of diverse presentations, multidisciplinary input and support. More about all this in another post.

  • Seize opportunities for assessment work that will allow me to diversify my skills e.g. varying ages, presentations, differential diagnosis

    Spoiler alert #2: I actually found myself two jobs! The second is assessment based and should give me lots of scope to do all the above. Plus, it’s also in a supportive multidisciplinary team.

  • As a long-term reader of Study Hacks*, working smarter not harder in building up my clinical decision-making skills is also part of my game plan. What on earth might that look like?
    1. Taking a month or so to identify a particular skill to work on. One that is going to be most useful for my clients and I.
    2. Spending a few weeks educating myself about that skill – who is it most suitable for, when should it be used, how is it used, what’s the best practice protocol?
    3. Spending a few weeks practicing using the skill (role-playing, adopting the skill for some first-hand experience of possible speed bumps in using and applying it).
    4. Introduce relevant clients to the skill, and incorporate into intervention plan if they’re on board with it.
    5. Seek and respond to feedback about the use of the skill from clients, team and supervisor.

Work towards endorsement

  • My Plain-English definition of this process involves completing:
    • Practice: 2000+ actual face-to-face or client related work hours specific to my area of endorsement
    • Supervision: regularly meeting with another psychologist to chat about my approach to intervention, conduct de-identified case presentations, discuss psychological theories, ethical and professional scenarios, assessment approaches, report writing, case cross-cultural competence etc.
    • Professional development: One-on-one and group supervision plus going to training workshops, reading articles and giving presentations etc.

      Spoiler alert #3: One of my jobs has an in-built program to assist me in gaining my endorsement. My contract is shorter than the time required for endorsement but worst case scenario, it’s going to give me a flying start.

And that folks, is roughly where I’m at with my plan. I suspect my move into private practice will occur gradually, probably by the time I’m a mid-career psychologist (5 year + mark).

Disclaimer:

It’s important to note that this is all a very simplistic account of supervision, endorsement and work in the public and private sectors. It varies according to country, training, the employer and the psychologist. Some graduates do go straight into private practice and flourish. Perhaps because they have found a supportive team of practitioners to guide them or, because they have previous experience working in health. Different strokes for different folks as they say. Hopefully this post gives you a bit of insight into one of the pathways of many early career psychologists and why I’ve chosen this particular path myself.


*I’m a big fan of Cal Newport and his blog Study Hacks. He has some really interesting perspectives on applying the idea of working harder not smarter (and deliberate practice) in various fields. I’d strongly recommend browsing through his blog if you’ve ever had career, study or creative aspirations.

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The Five Year Plan

McLeod’s Daughters, an Aussie TV show, follows a group of women as they negotiate the challenges of life and running a cattle station in the outback. It’s been a long-time since the show first aired, but it’s definitely worth a watch if you haven’t seen it yet.

Over the past few months as I’ve tried to map out where my career might be headed next, I’ve been reminded of Kate, one of the drovers on McLeod’s Daughters. Kate always had big ideas, tenacity and, a need to organise; she had a massive five year plan taped to her wall complete with short, medium and long-term goals!

Like Kate, I’ve always been a planner, at least when it comes to work or study. So I had a plan for how I would become a psychologist:

1) Get good enough grades in Year 12 to get into an Honours program,

2) Gain experience in the field to test out whether psychology was definitely the right fit and to give me a good chance of getting into a postgraduate program in psychology,

3) Seize every opportunity to develop my research, teaching and psychological practice skills and to develop an area of specialty

4) Walk out of uni being able to research, lecture and/or practice as a psychologist.

I first laid out these plans when I was 17, well at least points 1 and 4. Point 2 was added by the end of my first year of uni. And truth be told my pursuit of point 3 was a mixture of deliberate planning and happy accident. I soon noticed that the happy accidents led me to some really interesting places. And it’d be fair to say that my mantra became “this scares me and will be a logistical nightmare, but it’s really going to teach me a lot of things… Sign me up!”

It is very surreal to look back on all those plans and realise that I’ve more or less achieved them. Sure, some things changed as I went along, as they should with any good plan and the influence of serendipity, but now here I am – a psychologist and soon to be qualified academic. It honestly still doesn’t feel real typing that out.

Having reached the end-game of my decade long plan of becoming a psychologist I’ve had some time to think about where my journey might be headed next. At this stage, I have a broad strokes plan:

My main goal is to move towards working as a psychologist in private practice. There are pro’s and con’s to work in the public and private sector, but longer term I feel that private practice is the best fit for me. Chiefly because it will give me greater flexibility in how I operate as a psychologist and how I structure my work-life balance.

I also have a side project that’s important to me too. I’d like to get my research published and some of its more practical elements being used by other psychologists. Long-term that might even involve some consultancy work, outreach and policy development. Who knows? This particular scheme might well take a good ten years to come to fruition, but that’s okay.

I wonder in another five or ten years, which parts of this broad strokes plan will come to fruition, which will change, and how I’ll get there? In my next post I’ll flesh out the private practice plan and how that links in with my job search. Stay tuned 🙂

 

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