Your First Year as a Psychologist: When Floristry Becomes a Legitimate Career Move

I’m not going to pull any punches here. The first year as a psychologist is hell. Based on conversations with friends, this seems to hold true for other helping professions. Perhaps it’s just a universal thing about your first year of full-time work? All I can say, is that the learning curve for me was more challenging than undergrad and postgrad put together.

Why on earth am I telling you this?      To pay it forward. I wish someone had told me before I started my first year. I was lucky because my supervisor did tell me this as a new grad. Roughly paraphrased, my supervisor said that the first year is hard because it’s the most rapid period of personal and professional growth you’ll likely experience. And while my career has barely started, I can confirm that that learning curve was the steepest I’ve encountered thus far. And this is coming from someone who enjoys  chucking myself in the deep end whenever I can to figure out new ways to swim. Hearing that message from my supervisor, was one of the most helpful, freeing and relieving messages that I very much needed to hear that year.

If you’re in your first year or early career and feel like you’re barely keeping your head about water…     Please know that this does not mean you should be a florist instead of a psychologist! I have no idea why, but almost every psychologist I’ve met considers floristry as their ideal alternate career – PLEASE EXPLAIN?! The fact that  alternate career paths have come up in conversation many times with other psychologists also underscores the fact that questioning why on earth you ever decided on this career and if you are  cut out for it, is perfectly normal. So the good news is that if you feel like you’re flailing madly, it’s okay, you’re just human. BUT, do bring it up in supervision. And please seek out other psychologists at the same stage of their careers and tell them how you’re feeling. Chances are you will be met with a chorus of “oh thank goodness, I’m not alone!” and “Really? You feel like that too?! I’d never have guessed.” To do this job, you need a tribe. You really can’t pour from an empty cup.

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Second, it’s probably useful to pick apart why the first year is so damn hard. So here are my musings.

  1. It’s mind bending trying to get your head round whatever sector you’re working in and just how much it Does. Not. Fit. with how you’ve learnt psychology is practiced. That’s not to knock any of the learning or experience you bring with you from university and placements. It’s just that it’s not representative of the complexity of the clients and systems you will encounter ‘Out There.’ This does not mean you are not capable of applying your old learning to new situations, just that you’ve got a bucket load of accommodation to do, in the Piagetian sense of the word.
  2. Now that your world view of psychology is being shaken frequently and hard, you’re also having to figure out what psychology means to you, and how you practice it. Rather than simply emulating your supervisors or the texts, you’re working out how you do things now. You might also find yourself having to advocate for what psychology is and has to offer. All that takes guts and trial and error. It’s also a lot of fun and really rewarding when you actually start to get a sense of your own style and you see the fruits of your labour as an advocate.
  3. At some point you’ll likely also find yourself trying to set up processes to automate things a bit and lighten the load. That can be an exciting process because you probably have more freedom to decide how you do things than you have before, even if you do work within an existing system. On the flip side, having choice also means you have a lot of things to figure out to create these processes. And that takes time. How are you going to structure and run your intake assessments? What key things will you make sure to focus on in a first session? What assessment tools do you favour? How do you use them? How are you going to structure your case notes? What therapies will you draw from? Want to know the good news? You can change your mind. A lot.
  4. And then there’s the clients. I harp on about this a lot, but you are going to come across more firsts with your clients in one week than you probably did through all your years of training. This means you will find yourself regularly having to swot up about things. Different disorders, assessment tools and interventions; the clinical decision making around what presenting issue to target first and why; and how to adapt your approach for different age-groups, genders and cultures etc. This is normal. You will never know everything. There’s just too much to know. What you walk into your first year with is the building blocks to continually build that knowledge for the rest of your career. Just make sure you are mindful of the limits of your competence and you’ll be fine. Supervision is your friend.
  5. Somewhere in the midst of all of the above you’ll also be trying to get a sense of what bits of psychology you like best, what your strengths and weaknesses are, how you support yourself to do this work, how to juggle a caseload, use supervision, and to do it all  while functioning as a human being.

Clearly, it’s a lot. Is it any wonder you might find yourself entertaining floristry? That’s not to say that floristry doesn’t have it’s own challenges and isn’t a valid and rewarding career path in itself. Personally though I contemplate running off to be a busker on the hard days. I think that would be safer for the flowers.

Third. It gets better.    When you start to get your head round point 1 above, and make some head way with point 3, you then have more head space for points 2, 4 and 5. That does not happen overnight, but it does happen. This is definitely one of those annoying ‘give time time’ scenarios. For me, some things made the hardest periods of first year drag out longer:

  1. Not having the ‘this is bloody hard’ conversation with my supervisor earlier. I cannot stress enough how important it is to ‘keep it real’ with your supervisor. And if you don’t have a supervisor that you can do that with, find another or, a more experienced mentor psychologist that you can have these conversations with.
  2. Working across two work places with clients of different ages, in different systems and with very different populations also made things a lot harder for me. It meant that I had a dizzying degree of swotting up to do and that developing processes and honing skills also took twice as long. Sometimes it was hard for me to see progress in my skill development because I was chipping away, slowly, at so many things at once.
  3. Shifting worksites half-way through also had similar effects. I had to grow my systems knowledge and professional connections all over again. That took significant time and energy.

Despite these factors making things even more challenging for me in my first year, I don’t regret them. I had to do these things to figure out what did and did not work for me and it helped me, slowly, to learn that supervision is about supporting your practice not just for reviewing and developing session plans for complex clients.

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So what is the take home message?    You’ve got this. You really do. If you just take it one step at a time and cultivate your support crew, you are going to learn so much and enjoy it.

And just in case anyone reading this is still wondering why anyone signs up to do this job… As much as the work is bloody hard at times, my clients and colleagues keep me invested. When I see clients hanging in there through difficult times; taking their first steps towards recovery; choosing to discuss a relapse, tough things or the things that make them smile; sharing or applying the things they have learnt – I think to myself ‘this is why I do this.’ For these opportunities to witness growth and to help people figure out how they can help themselves be the best version of themselves they can be. It really is awesome in the traditional sense of the word. And in regards to my colleagues? They keep me invested because they allow me to play with ideas, learn from them, work with them and support and be supported by them. I am so grateful and richer for this community I am a part of.

 

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Bloom

Working as a psychologist is a tough gig. One of my roles involves working with individuals who experience low prevalence but highly complex and severe mental health difficulties. I enjoy this work because of the complexity and the challenge and the knowledge that just being with these people on their journeys for an hour a week can make a difference.

Despite the rewards, this type of work can be overwhelming at times. With a case load of such complexity, therapeutic goals are continually moving goal posts; clients may cycle rapidly back and forth between recovery, relapse and crisis and, I have a front row seat to horrendous accounts of ‘humankind’s inhumanity to humankind.’ When I’m navigating it all on the job, I think nothing of it, it’s just part of what I do. Knowing that anyone I might work with is doing their best, has the ability to recover (whatever that might mean for the person in question) and that I am very privileged when someone has chosen to share such accounts with me allows me to keep doing this.

Sometimes though, after work, my experiences can lead to some soul searching. Am I doing enough? Why do people treat each other this way? Are there people in the world who have not been touched by such pain, sorrow and cruelty? When I catch myself pondering these things, I focus back on the small victories at work and in life. Because the small things are the big things. It could be that someone simply came to session, that I listened with curiosity not judgement or I cooked myself a nice meal today.

And so, for every person I work with, also create a kirigami flower. It’s my way of recognising the individuality of each person I work with as a therapist, offering a wish for growth (theirs, and mine as a therapist) and, serves as a reminder to myself that by truly showing up for someone for one hour a week, I contributed in some way, however tiny, to helping them blossom. I have made twenty since I started practicing as a psychologist and intend to continue this tradition until I retire.

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Psychology: More than asking “How does that make you feel?”

Over the years I’ve had people ask me what a psychologist does or, had people begin to look very confused when I talk about doing anything something other than ‘just therapy or assessments’ in my work day. This curiosity and confusion makes a lot of sense. After all, you generally don’t get to see ‘a psychologist at work’ unless you yourself are a psychologist or a client. Even I’ve learned in these past six months as a qualified psychologist that there’s a lot more to it than even I had initially thought or experienced on placement. This post gives some insight for the curious about psychology beyond therapy and assessment (though that’s covered too) with some with some personal reflections thrown in. It’s a bit of an epic, so grab yourself a cuppa.

Psychology beyond therapy and assessment

Psychologists attend a lot of meetings, particularly if they work in large multidisciplinary teams. I once found myself in a meeting about having a meeting! Surreal.

  • “Hand-over” meetings are part of the daily life of a psychologist working in a large multidisciplinary team. The aim of these meetings is to update everyone about staffing changes, the movement of clients between services, to identify people requiring urgent support or assessments and, in some cases, to set-up home visits. Home visits serve a range of purposes including rapport building, an opportunity to assess mental state or, to provide social, therapeutic, functional or medical support.
  • Team meetings are also held across the various settings a psychologist might find themselves working in (including private practice based teams). However, these types of meetings don’t happen every day. The focus of team meetings is to review how the team is functioning, to plan and organise changes to service delivery (e.g. new groups and programs) and to celebrate achievements.
  • Psychology specific meetings may also be attended by psychologists. For those psychologists working in large multidisciplinary teams, these meetings usually happen once a quarter and are attended by all the psychologists in the region so they can check in about how therapy is being rolled out across the district, streamline or expand services and address any administrative issues. Typically these meetings also feature some sort of professional training component. Psychologists in private practice settings might also regularly attend psychology specific meetings, perhaps as part of an interest group of psychologists using a particular therapy approach or working with a particular population. However, generally, psychologists in private practice attend far fewer meetings than those in larger private sector or public sector organisations.
people coffee meeting team

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Psychologists also do a lot of continuing professional development. In my country, each year as part of licensing obligations psychologists must complete a minimum number of professional development hours and, keep a log and written reflection of this training. The aim of this system is to keep psychologists up to date with the latest approaches and tools and changes to diagnoses or systems to ensure ongoing evidence-based care. This happens through two pathways:

The first pathway is supervision. Supervision involves a psychologist meeting with one or more psychologists to review the way they practice. In my country, psychologists need to to this approximately once a month. Early career psychologists and/or psychologists training for further specialisation tend to have supervision more frequently (more like at least once a week a fortnight). Some people will receive this supervision through work. Other people may have to seek supervision out and/or pay for it, outside of their work.  During supervision psychologists review:

  • Case-conceptualisations. These are frameworks based on a theoretical model of each disorder/life stressor that captures how various contributing factors interact to exacerbate or alleviate symptoms for a client. These frameworks then guide treatment and assessment approaches.
  • Therapy and assessment techniques. These aspects are reviewed to explore whether they can be applied or interpreted more effectively. This process might involve practicing these techniques with a supervisor.
  • Personal practice. This element of supervision involves reflecting about the way you practice in the broadest sense, to monitor what is and isn’t working. A psychologist might talk about balancing their case load, professional development plans or self-care strategies to prevent burn-out.

The second pathway for continuing professional development is through training opportunities. This may include attending workshops and conferences, reading papers, watching webinars and listening to podcasts. Some of these opportunities may be provided at work. However, a lot of psychologists do additional training beyond this. Some need to source this training themselves because they are self-employed or, because the professional development opportunities provided at work do not completely satisfy their licensing requirements or training needs.

As an early career psychologist it can be hard knowing where to start with continuing professional development  because just about everything would be really useful! By the same token though that means you can’t go too far wrong whatever you choose.

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Psychologists can also provide consultation. Consultation may be given to other psychologists, health professionals and the general public. The aim of this process is to provide people with tools to better support people facing challenges with their mental health. Consultation can be a formal process such as a presentation to one’s team, service or a community group. These presentations are usually about a particular symptom, disorder or therapeutic approach. I like to make mine as practical and interactive as possible. Sometimes, within a large multidisciplinary service (and with the client’s consent), presentations are also given to the treating team about a specific client to better coordinate their care.

Consultation can also involve ad hoc conversations with other psychologists or service providers seeking a psychological perspective for addressing or assessing particular issues. For example, a psychologist might be called on to weigh in about risk assessment, how to manage challenging behaviour or, to assess whether psychological therapy might be useful when a psychology referral is being considered.

Providing consultation was not something I realised fell under the umbrella of a psychologist’s work day until I began practicing as a psychologist myself. It was a nice surprise! Part of the reason I initially did a Clinical PhD was to use my knowledge of psychology to promote learning and share my understanding with others. So, my consultancy roles allow me to do those things even though I’m no longer pursuing academia. As a consultant I also get to see firsthand the outcomes my input leads to, which is a real privilege and helps me learn too. Providing and seeking consultation is something I really enjoy and value as part of my job. 

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Sometimes psychologists provide case management, typically as part of their role in a large multidisciplinary service. They liaise with the client and other service providers to ensure continuity of care. This might involve checking in via a telephone call or home visit and/or liaising with other health professionals involved with client’s care such as their GP, OT, social worker or support worker (with consent) to provide and learn of updates about therapy progress, stay on the same page and enlist support for the client for homework activities.

I’ll also add admin tasks in here. This ranges from booking appointments, rooms and equipment through to organising professional insurance, registration and clearances for working  with certain populations. Billing and paperwork (e.g. consent to receive services, release information etc.) also fall in this category.

I find case management and admin the most challenging aspects of these aspects of psychology beyond therapy and assessment. Probably because they are least familiar to me. I remember remarking on my first placement that the hardest part was figuring out how to use the temperamental EFTPOS machine, not providing therapy or assessments!



Therapy and assessment

Now I’ll dive into areas of psychology that you have probably heard more about: assessment and therapy. Some psychologists primarily do one or the other, though there are usually elements of each in whichever role you are working in. What exactly is assessment?  Here are some examples:

  • Initial assessments – A clinical interview conducted to identify presenting concerns, current and historical coping strategies, symptoms, social supports etc. when someone begins therapy.
  • Risk assessments – A clinical interview or structured assessment conducted to evaluate a client’s risk to self and others and vulnerability to harm/misadventure
  • Diagnostic assessments – Screening for a range of specific disorders using clinical interviews, behavioural observation and/or formal assessment tools
  • Intellectual assessments –  Formal assessment tools are administered to examine current cognitive functioning, including memory and information processing, to identify strengths, weaknesses and adaptive functioning (ability to complete activities of daily living etc.).
  • Functional behaviour assessments – Examination of the triggers, responses and reinforcement of behaviour of concern targeted for change.
  • Educational assessments – Formal assessment tools are used to to compare intellectual and academic performance in order to identify and explain any discrepancies in functioning and make recommendations for support and intervention. The list goes on…

The nuts and bolts of assessment work involves selecting the appropriate assessment tools or interview; conducting the assessment; interpreting the scores and information; writing reports; providing feedback and, making recommendations for further interventions, assessments or service options.

Psychological assessment is a highly specialised skill. Administering and interpreting  assessment tools can be time consuming and complex. Many of these tools require specialised training to use and it takes a lot of practice to become fluent. Report writing is also complicated. The psychologist must pull together all the information available, explain test outcomes and implications, make recommendations and provide clinical judgements in a way that is easily understood. Psychologists in assessment roles may also contribute to policy development, determining service eligibility and advising in legal proceedings. For example, a psychologist might develop eligibility criteria for services based on assessment outcomes, verify diagnoses to determine whether additional funding may be provided to support a client or, provide expert testimony in court.

Beyond these specialised assessment skills, psychologists in assessment roles also make use of their therapeutic skills. Assessments just don’t work without the ability to build rapport, respond to the broader impact of presenting problems on the person’s life and support systems and, manage distress. The assessment process itself can also be therapeutic, allowing people to feel heard, understood and valued.

Assessment work as a psychologist can be very challenging but rewarding. Often people tend to have more of a preference for one or the other. I really enjoy both. For me, the best parts of assessments are getting to the bottom of things, seeing the positive impact that understanding has for the client, and working with the complexity of it all. Assessments always keep me on my toes and learning something new. As an early career psychologist it’s also quite rewarding, once you’ve put in all the practice, to notice that test administration and interpretation has become far more automatic.

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And finally, onto therapy itself.

Generally speaking, a therapy session runs for 50-60 minutes and typically takes place in a clinic. In some instances, psychologists will work with people in their home or out in the community though too, e.g. when they are doing exposure therapy.  For each therapy session, a psychologist will write up case notes and may also jot down things to be followed-up or explored next session.

When providing therapy support to families, a psychologist tends to split their time across a session so that they work with the caregiver/s, the young person and/or, all of the above at the same time. With adults clients, the psychologist primarily works one-on-one. Exceptions include providing couples therapy or, delivering group-based therapy programs which can also be provided to children and adolescents. Group therapy includes programs such as social skills training groups and DBT skills groups. Some psychologists also work in organisations providing one-on-one or organisation-wide interventions. For example, a psychologist might provide therapeutic support and consultancy in an organisation after a workplace incident, bereavement or natural disaster.

Some psychologists have a preference for one or two therapies. Other psychologists have a bigger tool-kit that they draw upon or are eclectic in their approach, using interventions from a range of therapies as needed.  There are many approaches to choose from: cognitive behaviour therapy, acceptance and commitment therapy, schema therapy, dialectical behaviour therapy (DBT), interpersonal therapy, solution focused therapy, eye-movement desensitisation and reprocessing therapy, exposure and response prevention therapy, cognitive processing therapy and behavioural activation, just to name a few ;). The choice of approach comes down to a combination of the evidence for the therapy’s effectiveness, the psychologist’s training, the client’s needs and the preferences of the client and psychologist.

Throughout the course of therapy, a psychologist frequently needs to do additional work beyond running the therapy session and writing up case notes. They might need to update their case conceptualisation, score assessment measures, put together therapy materials and session plans and, consider bringing any therapeutic issues to supervision meetings. This additional work might take an experienced therapist all of a few minutes to complete or consider unless they are supporting a client with particularly complex challenges or, are using a less routine therapeutic approach. However, for the early career psychologist, preparation work is regularly needed and can take much longer than a few minutes! This is because it takes time to develop fluency and familiarity with a wide range of presenting issues and therapy techniques and so, in the earlier stages, more preparation and ‘homework’ is needed for the beginning psychologist.

Regardless of a therapist’s years of experience, if a client is in crisis or high risk of harm to self or others, a psychologist will need to do additional case management, risk assessment, safety planning and/or mandatory reporting (e.g. of child abuse). In these situations, psychologists work collaboratively with clients to provide as much choice and agency as possible in managing safety concerns. Usually this involves looking at available support systems, services and coping strategies. However, sometimes a hospital stay may need to be considered to manage a high degree of risk. (Psychologists in assessment roles also case manage and provide risk assessments, safety planning and mandatory reporting as needed).

For years I thought I was going to be a psychologist that did assessments, not therapy. That plan evolved as I began volunteering and doing placements. I started to think about adding in therapy with children with disabilities, then children more generally, youth, and finally, adults. At the moment, the only population I don’t work with (yet) are children without disabilities! The gradual shift came down to really enjoying therapy and realising I had some strengths that lent themselves to this type of work.

I think a combination of therapy and assessment work suits me best. Quite what that will look like longer-term is a bit up in the air. Right now having so many different roles is giving me a chance to try things out, find my niche/s and work out my ideal balance.

For the sake of being able to look back on my predictions one day, here’s what I think might happen from the perspective of 6 months working as a psychologist… I am really passionate about my disability assessment work and love working with that team. So, I see disability assessment work remaining a part of my life, potentially ’til I retire. One day, that role might well expand to include a day for consultancy/policy/advocacy type work too.

Therapeutically, I’m less sure where things will end up for me. I guess because I’ve worked with people with a wide range of key concerns across several settings, some of which are still quite new to me, it’s harder for me to predict. I do see myself continuing to provide therapy longer term but with less of a weighting towards complexity in my case load than I have now. Perhaps I’ll do therapy two days a week, seeing a couple of people for trauma related issues, a couple more for anxiety/depression and another four with autism for support with anxiety/depression? I also suspect I will provide therapy in either an NGO team or group private practice longer term because I see lots of benefits in having a team round me, even if we are all working quite independently. 

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Typical work days”

Typical work days don’t really exist for psychologists. It really depends on the setting you work in and your specific role. This means some psychologists will do a lot of work in the ‘not-therapy-or-assessment-category’ and some will do virtually none (beyond professional development and supervision). Here’s a snapshot of some of my typical days in various settings

Setting 1: Therapy / consultation role [old role]

  • Morning meeting – 60 minutes
  • Individual therapy client – 60 minutes
  • Notes and session prep work – 30 minutes
  • Consultation – 60 minutes
  • Lunch – 30 minutes
  • Group therapy and notes – 70 minutes
  • Individual therapy client – 60 minutes
  • Notes, safety planning and case management – 30 minutes
  • Supervision – 60 minutes

You’ll notice that I didn’t run more than three therapy sessions a day in this role. This worked well for me, allowing me to do the prep work and crisis management I needed to do to manage a complex case load.

Setting 2: Therapy / assessment role

  • Morning meeting – 30 minutes
  • Home visit – 120 minutes
  • Individual therapy client – 60 minutes
  • Lunch – 30 minutes
  • Individual therapy client – 60 minutes
  • Notes – 30 minutes
  • Assessment interview – 90 minutes
  • Notes – 30 minutes
  • Supervision – 60 minutes

This role has a balance of case management and therapy which means I typically see three clients a day at most. Beyond the morning meeting, my therapy time-slots and tasks vary widely. One week my Monday might be full of case management tasks but the next I might have lighter duties which mean it’s less of a scramble to book in therapy, supervision and get to my admin tasks. The variety is good and having some on-call time for case management means I get to see and do things I wouldn’t normally, but scheduling in appointments can get a bit complicated!

Setting 3: Assessment role

  • Morning meeting – 5 minutes
  • Reviewing case files and assessment prep – 25 minutes
  • Interview / behavioural observation / assessment measures – 120 minutes
  • Assessment review with co-facilitator – 30 minutes
  • Assessment feedback – 30 minutes
  • Lunch – 30 minutes
  • Report writing – 90 minutes
  • Consultancy – 30 minutes
  • Liaising with stakeholders – 15 minutes
  • Training – 75 minutes

Some days I’ll substitute the training block for report writing or have another assessment after lunch. It all balances out nicely because I have regular report writing days factored in. I like the balance of having a fairly predictable day but variety to the work itself.

Setting 4: Therapy and admin role

  • Weekly meeting – 30 minutes
  • Reviewing case files and therapy prep – 90 minutes
  • Compiling therapy resources – 60 minutes
  • Case management – 30 minutes
  • Lunch – 30 minutes
  • Therapy session and notes – 60 minutes
  • Therapy session and notes – 60 minutes
  • Therapy session and notes – 60 minutes
  • Notes/admin – 60 minutes

This is a new role in a service that’s just being developed so it’s helpful having half the day for therapy and the remainder for admin while I’m settling in. It runs on more of a private practice model (50 minute session / 10 minutes for notes). I’m still getting the hang of that but enjoying working in a more structured clinic again.

Additional work, outside of work

  • Crisis management: Note writing, safety planning in consultation with the team and extra documentation about risk management sometimes means working a couple of hours overtime one a month. But it allows me to leave work at work and know I’ve done all I can and I compensate by leaving early later in the week to avoid burn out.
  • Supervision: I can have up to two hours of supervision a week at the end of my last day on site for the week. So, my supervision notes typically build up and have to get written after work in my own time. If I’m on top of things that can take about an hour a week.
  • Therapy prep: I put in an extra hour or so a week because of all the different populations and therapy approaches I’m working with. I’d like to be doing more proactively rather than reactively but fitting it in is hard.
  • Professional Development: I’m lucky to have some great free or cheap training options available in my area, usually with a social aspect for about three hours per month.

So it seems as if I’ve been doing at least five hours of unpaid work/training a week without realising! I don’t mind so much about the professional development activities – it’s social and feeds my inner nerd, but the rest needs to change!


So in sum, there’s a lot that psychologists do that doesn’t reach the news, isn’t reflected in the dodgy representations of psychologists in pop-culture and might not reach the ears of students in post-graduate training programs.

Hats off to you for actually reading this epic!

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The experience of learning to work with people who are feeling suicidal

There’s not much out there about what it is like to be an early career psychologist. There are books aimed at this demographic well worth a read (e.g. The Making of a Therapist, Letters to a Young Therapist), but they’ve all been written by people towards the end of their careers. I haven’t really found any birds-eye view accounts of what it is like to begin witnessing, learning and knowing things about this profession for the first time, or about the process of navigating all the personal and professional changes that all these firsts bring. The “Life as an Early Career Psychologist” section of this blog was inspired by this gap. This week’s post explores a very important issue for any early career psychologist: the experience of learning to support people who are suicidal. Given the topic, this post does mention suicide so if you feel it may be distressing for you, I encourage you to skip this one.

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“You should be a doctor” the other kids would say to me. Then I’d picture myself, scalpel poised, in the middle of surgery. Ugh!! It was never the blood and gore or years of study that put me off medicine. It was the fact that if I made one wrong move someone might die. Ultimately, I decided to become a psychologist… Because that required no degree of responsibility or that I work with people to help them stay alive, I say with tongue firmly in cheek!

My first experience with suicidality happened as an undergraduate psychology student on a work experience placement, well before any formal training to help with supporting people feeling suicidal. I would be lying through my teeth if I said that that experience had not at all anxiety provoking! Thankfully, my first instinct was to ask myself what do I need to do to keep this person safe? And so I made sure to seek support from the staff overseeing me who had the training that I had lacked.

Things were different when I began my formal postgraduate training to become a psychologist. By this time I had been taught about evidence based practices for supporting people who were feeling suicidal. And so, the next time I encountered someone contemplating suicide, my initial reactions were different, this time I thought about both the meaning of the disclosure and how best to respond. E.g. I am so glad this person has felt comfortable enough to tell me they are feeling suicidal. Am I doing everything I possibly can to get this person the support they need to help them stay safe?

While it is vital to understand the process of what to do when someone discloses suicidal thinking, it’s quite another thing fluently translating this knowledge into action to best support the individual in front of you. Hence, why psychologists are heavily supervised as they find their feet in this arena. Part of this process is about learning how you respond in these situations. I’d been worried I might become anxious and forget what to ask when faced with my first client who was feeling suicidal. I remember bringing these concerns to supervision and, as a result, I learned what I needed to do to remain calm and methodical.

Developing confidence in my approach to asking about suicidal thoughts and feelings didn’t happen overnight. There was just so much to consider. How should I go about assessing suicidality, especially for people who find suicidal thoughts, urges and behaviour difficult to talk about?  How do you go about weighing up what supports to offer and when?  This process got less clunky with time and practice and, as my knowledge of available support services and processes expanded.

My first experiences calling crisis lines and supporting people to present to hospital still stand out clearly though. In the moment I just did what I needed to do to help people keep themselves safe. At the end of the day though, I’d feel wiped out. So looking after myself in these high pressure situations was also a skill to be learned.  How could I balance my case-load and other responsibilities while responding to crises? What things did I need to do to prevent burnout? What did I need to do to look after myself when someone died by suicide? It was a lot of trial and error figuring out the best way to respond to these situations, and it looks different for everyone. You can’t truly know what you need and what works for you until you experience it firsthand but self-reflection and making educated guesses help.

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Developing all of these skills is an ongoing process. I’ve never felt, and will never feel, like I’ve 100% found my feet in supporting people feeling suicidal, or with any other aspect of my work as a psychologist. I’d be deeply concerned if I did feel that way, because that kind of thinking breeds complacency which can be dangerous. In my eyes, when you stop questioning your practice, you stop being the most effective psychologist you can be.

This continual learning and growth as a psychologist is what makes this job so challenging and so rewarding. And I suspect, that this challenge and growth is all the more amplified for those of us in the early years of our career. Not only are we coming to grips with the nuts and bolts of what to do in the face of great complexity, but we are learning about how we cope in often extreme situations, and how these experiences shape us personally and professionally.  I have noticed phenomenal changes myself in my first six months as a qualified psychologist both in my therapeutic approach, clinical reasoning and, in my perspective on life. During this time I’ve faced some incredibly difficult situations that have challenged me on every level. At the same time they have helped me to solidify why I do what I do; why I go about it the way that I do and, to learn about myself and what I need, to be able to do this work.

The one constant in my path as an early career psychologist, especially working with people who are suicidal has been hope. No matter the difficulties I face in doing this work, or the challenges the people I support are facing, I hold the hope that it will get better for them, that change is possible and, that what each of us does, however small, matters. Ultimately, I think that’s what allows me to work in this field, knowing that the challenges are more than worth it.

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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!

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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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Filed under Early career, Practice, Reflections

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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Filed under A day in the life, Clinical Phd, Early career, psychology, Reflections

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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