Thanks so much to everyone who's emailed me about the blog, it's great to know that people are reading it!
A couple of the emails I've received have led me to think about writing a publication (e-book?) about clinical psychology training so I have been busy making a start on writing it and hope it may be available September-ish.
So far it is more factual than the blog and will be focussed on the first year of training. I'm very aware of not wanting to position myself as any form of 'expert' in the business of clinical psychology training and feel it is important to state from the outset that it will be based on one person's experience and will thus be limited. However, by sharing what I have experienced of training to date I hope to give a flavour of what the day-to-day experience of training may be like.
Topics will include:
The University Experience -
Induction
Core competencies of training
Academic work
Research
Personal and professional development
The Placement Experience -
Pre-placement planning
Contracts
Observations
Placement reviews and assessment of your competencies
Supervision and how to problem solve
Note keeping and confidentiality
Caseload and competencies logs
The Clinical Experience -
Initial sessions (Introducing yourself, hypothesising, preparing the therapeutic space, skills of engagement, client expectations)
Assessment
Formulation
Case studies of client work that you can use to have a go at formulating
Models of Intervention
Endings
Cognitive assessment
General -
Financial aspects of training
Pros and cons of therapy
I hope it sounds interesting?! Please let me know what you think!
If you would like to be kept updated about when the book will be available and how to get hold of a copy, please email me: myclinpsychlife@gmail.com
I'd also be really grateful if you could include an idea of what you would most value learning from the book.
Other possible ideas might be:
Insights into working with particular clinical populations e.g. People with learning disabilities, older people, children
Ideas about working with particular clinical difficulties e.g. Depression, anxiety, substance use etc
Using a particular approach e.g. CBT, DBT, CAT, systemic, psychodynamic
Managing time demands of training
Ideas about certain epistemological approaches e.g. Social constructionist
Or all or none of the above or something completely different! All ideas are welcome....
Thanks!
Do you consider yourself a 'leader'? Increasingly, the NHS are looking to clinical psychologists to be leaders, so much so that BPS guidelines are soon to be including leadership skills as a core competency. I have mixed feelings about this development. Personally, I didn't pursue this career to be a 'leader' I came to work in a therapeutic way with clients in distress. My assumption is that the more time I spend leading, the less this I will have to work in this direct way with clients (and this is borne out in my observations of supervisors with leadership responsibility).
Despite this, I can see that clinical psychologists are relatively well paid in comparison to other health professionals in the NHS and it is only right that we should justify this in the form of extra responsibilities in the cash strapped NHS. Besides, when less qualified individuals can deliver CBT at half the cost, why would service providers choose us to do so?
A final thought is an optimistic one. If Clinical Psychologists are leading services then surely this will mean the NHS will become more psychologically minded? The medical model prevails but with services being led by clinical psychologists willing to step up and speak out, who knows where they could lead the NHS of the future.
By aligning ourselves with this language of professionals, are we missing out on the human connection that is integral to the therapist-client relationship in a way that isn't demanded of our relationship with our solicitor or bank manager?
This week I've been approaching my sessions with clients as one based on 'trust' rather than confidentiality and this experience has subtley shifted something. I've been more attuned to the humanity in what has been brought to the session. Rather than a head full of formulation and worry about what question to ask next, I've made space for the need to 'be there' for the client and be present. Formulations and asking appropriate questions are certainly integral to our work. But I have become aware as a trainee that I have been so focussed on getting these things right that I may have been avoiding something. The human pain of their experience.
Of course, our clients want us to help them to understand how their problem has developed and ways of intervening (ie. a formulation). But my sense is that this need not be at the expense of something which may be more fundamental – a human connection based on trust.
and those from the 'Overcoming' series.The tools of CBT were pragmatic and portable and they made sense to me. I quickly began to spot my own 'cognitive errors' - catastrophising, discounting the positive, labelling, should and must statements etc..... What strikes me about my own CBT was it's utility while I was seeing my therapist ..... However, once my sessions were over and I went back time and again to the books and the thought records, I had this dawning sense that despite knowing it in my head, I wasn't experiencing it in my heart, an observation that has been identified by Deborah Lee in her chapter in Compassion
I had this sense that there must be something wrong with me. I was 'working the programme' and superficially things were improving but deep down I still wasn't feeling 'right' -whatever that is.
And so with this in mind, how do I experience CBT from the other perspective - that of being the CBT therapist? I have worked with a number of clients using a CBT framework throughout my clinical training to date. Despite CBT theory emphasising the need to be collaborative (coupled with the desperate desire on my part to avoid positioning myself as the expert), it has been my experience that clients want me to be the expert - I am after all offering NHS funded services to the client (referred by their GP or some other similarly identified expert) as someone who can help them. And, implicit in the theoretical basis of CBT is the message, "Your thoughts are not the most helpful, let me help you change them". And I have seen people change their thoughts, schemas and core beliefs and been inspired and privileged to be a witness to this change. But I have also seen people for whom the thoughts that they were having may not have been the most helpful but were the most rational given their individual social environment. Someone living on the poverty line. Or the victim of racism, sexism or homophobia. In which case working with someone's thinking patterns feels like one small part of the jigsaw for whom those 8 NHS funded CBT sessions only succeeded in scratching the surface.
So...why the blog? Well, that's a complicated one. I’ve been wondering about what’s led me on this particular career path for a while now and I read recently (in Psychologies magazine I think) that it can be a good idea to think back to what you were interested in as a child. This can help you clarify what you enjoyed doing before being subjected to outside influences in the form of peers, media sterotypes, parental expectations and the like! The theory is that this can provide clues as to what your 'signature strengths' are. You might know that psychologists in the field of positive psychology (e.g. Martin Seligman, http://www.authentichappiness.sas.upenn.edu/Default.aspx) have found that identifying our signature strengths can lead to a sense of 'flow' (http://en.wikipedia.org/wiki/Mihaly_Csikszentmihalyi#Flow) - the state of being so immersed and absorbed in the enjoyment of one's activities that other concerns become immaterial. This led me to think about what I enjoyed as a kid and whether this bears any resemblance at all to what I’m now doing as a trainee clinical psychologist ;)
Well I have definitely always been more of a listener than a talker which I guess could be a valued quality of a CP. But what I remember most is happily spending hours reading - fiction, non-fiction - whatever I could lay my hands on really. I don't readily admit this but I was actually quite into ‘how-to’ guides (things like the Girl Guides Handbook springs to mind!) - it was the 'improve yourself' aspect that I loved and I guess some might argue this bears some similarities to what a CP is all about, (although my psychoanalyst would of course be making links with other reasons why self-improvement and wanting to be different captured my interest...but that's a story for a different day). And the other thing I loved was writing – putting thoughts into words and making experiences come alive.
So in a round about way I guess I'm wondering about how to get back in touch with those early interests. But why so publicly, on a blog? I think I'm a funny mixture of show off and wallflower. I like the idea of putting my ideas ‘out there’ in some way but at the same time am hugely aware that the world of clinical psychology is an incredibly small one. So this blog will stay as anonymous as it can be. Plus if you’re reading this as a graduate psychologist and thinking of applying for training I think there may be space for some real life experiences of clinical psychology. If so I hope it may be a source of insight for you.
Another reason for wanting to do some writing is that I recently discovered that it can be very therapeutic. A study conducted with people with experiences of chronic pain demonstrated that self-expression in the form of writing helped with their ability to manage their pain, whether or not they chose to write about their pain or another topic entirely (this isn’t the study but a link to the general topic: http://chronicpaincontrol.net/expressing-yourself/writing.php) I don’t suffer with chronic pain but I do have a different health problem to manage so I began to wonder if putting some of what I’ve been experiencing in training down in black and white may help me to make sense of it. It all feels very unknown. Risky even. But I’m aware of the many times I’ve said to my clients when faced with embarking on a behavioural experiment of some kind in CBT, “What have you got to lose? It’s an experiment – whatever the outcome we can learn something”. So it feels like it might be time to take my own advice. Here goes.
