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.

man wearing black polo shirt and gray pants sitting on white chair

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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.

art assess communication conceptual

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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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