Tag Archives: early career psychologist

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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Filed under A day in the life, Early career

You’re not in Kansas anymore…

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

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

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

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

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Filed under Early career, Practice, Reflections

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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Filed under Clinical Phd

The Making of a Therapist

The inaugural Psychology Book Club post is here!

This month’s offering is “The Making of a Therapist” by Louis Cozolino.

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The Whistle-Stop Tour

  • Intended audience: Trainee and early career psychologists
  • Content: A 213 page guide to common pitfalls and experiences of the new therapist
  • Readability: Easy to read and relate to with plenty of ‘take home points’
  • Practicality: Questions posed throughout help you work out how to apply the advice
  • Cost: Kindle $AUD 21.50; Hardback copy from the Book Depository $AUD 35.67
  • Publication details: W.W Norton and Company Ltd. 2004
  • Overall rating: ★★★★★

 

The Extended Review

I’ve read a few books aimed at early career psychologists but this is easily my favourite. Cozolino provides a witty, honest and practical account of the common concerns of new therapists and how to address them. The book is split into three sections: getting through your first sessions, getting to know your clients and getting to know yourself. He covers just about everything from Imposter Syndrome to counter-transference. Don’t be put off by the Freudian language though. I found that it all made sense and could easily be applied in my own clinical work even though I don’t come from a psychodynamic orientation.

The take home points for me were Cozolino’s observations about self-knowledge, the idea that we each need to be aware of, manage and even make use of, our own personal experiences and biases within the therapy room. Cozolino’s stance on this issue was that simply “being professional” by making sure we are aware of ethical codes, guidelines and our own limitations isn’t enough. Too often being professional means staying only “above the neck” and something I’m realising in my own training is that you can’t do therapy well if you’re completely in your head.

I feel I don’t have the words to explain this idea well enough. I guess it’s one of those things you have to experience yourself to truly appreciate the difference but perhaps the infinite wisdom of  Heart and Brain from The Awkward Yeti comic series will help. I think doing therapy above the head is like leaving Brain completely in charge, he gets the job done but sometimes he misses the point entirely and makes things unnecessarily difficult. The view Cozolino and I share is that ideally therapists harness Brain and Heart, allowing Brain to focus on the theory, the science, the ethics and the strategies and Heart to focus on being present, open to experiences and meeting needs to build therapeutic rapport and model healthy coping. This latest offering from Nick Seluk about Brain and Heart seems pretty apt: http://theawkwardyeti.com/chapter/heart-and-brain-2/.

Price wise, ‘The Making of a Therapist’ might be a little out of reach for the student budget. However, I consider this book recommended reading for all trainee and early career psychologists who do therapeutic work, so maybe try to find it in your local university library if you can.

I’d love to hear your feedback on ‘The Making of a Therapist’ if you’ve read it and other recommendations – reading and professional for early career psychologists.

~ Honourable Mentions ~

 

 

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Filed under Clinical Phd