As an undergraduate I imagined my future self as what I considered to be the archetypal clinical psychologist, attempting to change the world by banishing one ill-informed stereotype at a time, and by helping patients in distress. Before training, I was constantly eager for any ‘real experience’. I interpreted this as working with distressed individuals through therapy while doing some research on the side. Subsequently, in my first placement I was surprised to discover that my caseload would be a fraction of the number I held pre-training. This coincided with a question asked by patients, colleagues, and friends alike: what does a clinical psychologist actually do?
My observations on this question 1 year into training as a clinical psychologist are what follows.
Many people are aware that clinical psychologists work with patients across the lifespan, and experience those with physical and/or mental health problems in many different settings. This is entirely true; however, our training is unique in that we develop skills in a wide range of therapeutic models. We hope that this breadth of expertise enables us to work towards reducing the distress and improving the wellbeing of those experiencing difficulties. We offer a listening, non-judgmental ear to our clients; hoping to show that we can cope with, and contain, their distress and help them generate a more coherent narrative for themselves and those around them. A core aspect of our work includes identifying and working with patients’ values, fostering resilience, and helping them reach their goals.
So what happens in the time when we are not with our patients?
Over the past year, I have learned of the many other ways in which we can help patients and potential service users outside of the therapy room. Both trainee and qualified clinical psychologists are using research skills alongside advice from their colleagues to develop more sustainable and effective services in an evolving NHS. This may include providing our clients with robust, evidence-based treatments, as well as utilising practice-based evidence to routinely monitor patient outcomes. These skills are also used to evaluate the services we work in. For example, such projects may involve attempts to understand barriers to treatment. Crucially, we also aim to prioritise and give voice to those with experience of mental illness in order to challenge outdated processes and improve the services intended to support them.
I have also seen how psychologists use their reflective skills to help their fellow psychology and MDT colleagues make sense of challenging relationships with their patients, other colleagues, and the NHS as an organisation. One can see how staff and patients alike can easily pick up on one another’s feelings of anger, distress, anxiety, and so on, which can be acted out in pressured environments. As reflective practitioners, part of our role is to help both ourselves and our colleagues monitor and recognise our own thoughts and feelings and the impact these may have on our relationships.
As I approach the end of my first year of training, one thing that strikes me is the desire of other professions to be more ‘psychologically-minded’. The training and consultancy that I have witnessed clinical psychologists offer their colleagues appears to be appreciated. This is important, because in an evolving NHS there is no room for an ill-informed view of mental health. Thankfully, many seem to share this sentiment.
While initially I eagerly anticipated direct therapeutic work, I can now see that the indirect work clinical psychologists can offer is crucial for an evolving NHS; a daunting but exciting prospect for a trainee. So what does the archetypal clinical psychologist do? All of the above. With a little mind reading thrown in there for Freud’s sake…