Category Archives: Clinical Phd

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.

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.


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. 

 


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.


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. 


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 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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So you’re a psychologist, now what?

While my postgraduate psychology training has equipped me with many skills, much less time was spent on the nuts and bolts of setting myself up as a psychologist. Suddenly I have to get my head round registration, indemnity insurance, Medicare numbers, award levels and figure out whether work opportunities are suited to a very early career psych.

Here’s what I’ve learned  in case its of use to anyone else starting out.

Registration

It varies on where in the world you are, but chances are that there is a lot of paperwork between you and being able to call yourself a psychologist.

Tip: Presume nothing and ring the registration board about anything on the form you are unsure about. Generally presume it will take at least a few weeks to get processed.

Indemnity insurance

What is it? Legal protection for you as a professional. In Australia its mandatory. Some work places will cover it for you but you’ll generally need your own if you are working in private practice.

Tip: If you are a member of your local psychology organisation, you may be eligible for a discount on professional indemnity insurance. But do shop around.

Medicare numbers

If you want to provide services under Medicare you need a Medicare Provider number. To get a Medicare Provider number you need to be registered and have a place of work. This can leave you in a bit of a Catch-22 when you are applying for registration, on your first job hunt and therefore without a place of work!

Tip: You need a Medicare Provider number for each place of work. It can take up to six weeks.

Award levels

PUBLIC SECTOR

If you are going into the public sector in Australia and have a postgraduate degree, the entry level positions in the public sector open to you are at AHP2.

PRIVATE SECTOR

There are many different arrangements in the private sector from independent contractor through to salaried staff member. Private practices  often (but not always) advertise positions for people who have previously worked in the field for a couple of years and/or who hold an endorsement in a specialty area.

Tip: Read the fine print. Not all AHP2 jobs are entry level and some private sector jobs are aimed at new grads.

Where to start?

That seems to be the million dollar question, everyone has an opinion and these opinions often conflict. I suspect the only clear answer is “start somewhere.” Having said that, here are some questions that might help you out:

  • Is your CV up to date? Do you have three professional referees? What clearances do you have that allow you to work with specific populations?
  • Do you want to pursue endorsement in a specialty area? How might that work?
  •  Is supervision provided? How might you obtain it?
  • Do you have any preferences? Rural vs metro; public vs private sector; child vs adult; assessment vs therapy; part-time vs full-time; a specific population you particularly enjoy working with?
  • Where are your competencies? Do you have skills in particular techniques, therapy formats (individual vs group) or environments (team vs solo practitioner)?
  • And of course, what opportunities are available?

Best of luck, any hints and suggestions welcome!

 

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