Becoming a Clinical Psychologist

Everything You Need to Know

Steven Mayers, Amanda Mwale

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9781351976084
• Edition: 1
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Becoming a Clinical Psychologist: Everything You Need to Know brings together all the information you need to pursue a career in this competitive field.

This essential guide includes up-to-date information and guidance about a career in clinical psychology and gaining a place on clinical psychology training in the UK. It answers the questions all aspiring psychologists need to know, such as:

• What is clinical psychology?
• What is it like to train and work as a clinical psychologist?
• How to make the most of your work and research experience.
• How to prepare for clinical psychology applications and interviews.
• Is clinical psychology the right career for me?

By cutting through all the jargon, and providing detailed interviews with trained and trainee clinical psychologists, Becoming a Clinical Psychologist will provide psychology graduates or undergrads considering a career in this area with all the tools they need.

1

WHAT IS A CLINICAL PSYCHOLOGIST?

Clinical psychology can be described as the ‘psychological specialty that provides continuing and comprehensive mental and behavioural health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice’ (APA, 2017). As this definition suggests, the role of a clinical psychologist is varied and continually changing in the context of Health and Social Care in the United Kingdom (UK). Clinical psychology did not always look like it does today, the profession is relatively young and has changed a great deal over the past 60 years. For an extensive understanding of the history and development of clinical psychology in the UK, see Hall, Pilgrim and Turpin (2015). Today, clinical psychologists generally work in Health and Social Care settings that include hospitals, health centres, Community Teams, Specialist Services and Social Services. Typically, they work as part of a larger team with other health professionals. Most of the clinical psychologists in the UK are employed by the National Health Service (NHS), some work for third sector organisations (such as charities), in private practices and some are engaged in community-based projects.

WHO DO CLINICAL PSYCHOLOGISTS WORK WITH?

Clinical psychologists are trained to work with people of all ages and often support some of the most vulnerable people in our society, which can include children adolescents, adults, couples, families and older adults. The support of these people will usually take place in an Inpatient or hospital setting, or in Outpatient Services such as a clinic or in the community. Clinical psychologists work in Mental Health, Physical Health and other settings such as Learning Disabilities Services, Forensic Hospitals, Addiction Services, Brain Injury Rehabilitation Services, Homelessness Services, and others.

HOW DO CLINICAL PSYCHOLOGISTS WORK?

Many clinical psychologists work with people who are experiencing psychological distress. Examples of common difficulties that clinical psychologists come across are often described as depression, anxiety, psychosis, post-traumatic stress, addiction and so on. In the context of the common language used to categorise problems, clinical psychologists are less interested in how to label a problem but are more concerned with how to understand and make sense of it (Johnstone, 2000). Clinical psychologists would usually do four things when working with someone:

1 complete an assessment;

2 use the assessment to understand the client’s difficulties (known as a formulation);

3 complete a therapeutic intervention;

4 evaluate the effectiveness of their approach.

Clinical psychologists are both ‘scientist practitioners’ and ‘reflective practitioners’ (Llewelyn & Murphy, 2014). As ‘scientist practitioners’, clinical psychologists use therapy approaches that research suggests are useful in helping people who are experiencing psychological distress. In addition, they can apply their understanding of psychological research and knowledge in different situations in a variety of ways. As ‘reflective practitioners’, clinical psychologists are encouraged to think about their work so that they can adapt to best support the individuals that they’re working with. These approaches are emphasised throughout the training process with continued supervision and professional development.

Assessment

Clinical psychologists try to make sense of people’s difficulties by gathering information (an assessment) and then trying to make sense of how the problem functions in that person’s life (a formulation). The assessment process often considers a person’s early life history, family history, including the quality of parenting, social history, close relationships, experiences of traumatic events, disadvantage, deprivation, disability and discrimination. The assessment will, whenever possible, be collaborative and involve the individual receiving psychological support. Often psychologists use an interview format to gather information, as well as using questionnaires to determine the severity of specific problems, e.g. sleep, low mood and anxiety. Sometimes clinical psychologists will need to carry out detailed specialised neuropsychological assessments, which assess the impact of conditions affecting the brain, such as brain injury, stroke and dementia. These are often carried out if a person experiences difficulty with their memory, information processing and attention span, amongst other things, which may be impacting on their wellbeing and quality of life. Psychologists can also gather information through observing behaviour, e.g. observing a child’s classroom behaviour in a school for pupils with additional needs, making use of reports and information gathered by other professionals and relatives of individuals who require support.

Formulation

People who are experiencing psychological distress are often experiencing an understandable reaction to unusual or overwhelming events (Bentall, 2003). Whilst gathering information during the initial assessment, the clinical psychologist will work with the individual or team to develop a shared psychological understanding of the difficulties before determining what might be the most useful approach to supporting the person. As a result, it is important to consider the individual’s background and life circumstances and how these experiences have impacted on their current problems. The formulation will attempt to make sense of the information gathered in the assessment and will also include information about factors which may keep the problem going and the things that might help to keep the person well. The psychological formulation can take various forms depending on the approach that the psychologist prefers to use. For a summary of the process and different types of formulation commonly used by clinical psychologists, see Johnstone and Dallos (2013).

Psychological intervention

Following assessment and formulation, psychological support will then be given to people who require it, sometimes using a specific form of psychotherapy. There are wide range of therapies, which you don’t need to understand at this point, but they include Cognitive Behaviour Therapy (CBT), Compassion Focused Therapy (CFT), Acceptance and Commitment Therapy (ACT), Cognitive Analytic Therapy (CAT), Mindfulness Based Cognitive Therapy (MBCT), Dialectical Behaviour Therapy (DBT), Psychodynamic Psychotherapy (short- and long-term) and Systemic Family Therapy. Some clinical psychologists integrate elements of different models into their intervention to facilitate an individualised approach to therapy. Clinical psychologists can also facilitate group therapy sessions based on these models and those specific to group therapy, supporting people to develop coping skills for managing particular problems within a supportive and safe environment.

Evaluation

Before, during and after an intervention, clinical psychologists will be looking to evaluate their work. For example, if delivering therapy, the clinical psychologist may want the person receiving support to complete a questionnaire that provides a measure of a specific area of functioning, e.g. anxiety, as mentioned earlier, and they will want to determine if this has changed following the therapy. To do this, they will complete these measures again during and after therapy and then after several weeks following the intervention if possible. The reason for doing this is to determine if the therapy has been useful for the person. Clinical psychologists will often use session-based measures to facilitate a conversation with the person receiving therapy about how they feel it is going and to make any adjustments if necessary.

Communication

Effective communication is central to the role of a clinical psychologist (Llewelyn & Murphy, 2014). Clinical psychologists are generally very good communicators with excellent literacy skills. Clinical psychologists will write reports to a wide range of people, including professionals and family members and they are able to adjust their face-to-face communication style to meet the needs of an individual. These skills in communication enable the clinical psychologist to be effective in a range of roles explored below.

Teaching and consultation

Clinical psychologists are often involved in the teaching via staff training to help improve interactions with service users that professionals may find challenging. This will usually be presented in a more structured way and could include training designed to equip nurses on a stroke and brain injury rehabilitation ward with skills in developing a behaviour support plan for a service user. Another example of a teaching role is providing individual or group supervision to trainee clinical psychologists or staff who are using psychological therapy. Consultation can involve developing psychological formulation and recommendations with other colleagues in both formal and informal ways. The consultation is often less structured than teaching and allows for staff members to have a conversation about concerns they may have from a psychological perspective. The consultation and teaching helps others to develop a psychologically informed understanding of teams, systems and an individual’s difficulties, which they may find challenging.

Leadership and service development

The ability to communicate effectively and develop relationships with others is required for effective leadership and management. Clinical psychologists are particularly good at this because they have excellent communication skills and are trained to understand the human mind and behaviour. Relationships are fundamental to the practice of clinical psychology and are another aspect of what makes clinical psychologists excellent leaders. Clinical psychologists can also become leaders in the ‘co-production’ of services. This is due to their work experience and training in considering multiple perspectives of a problem, developing hypotheses and new ways to reconsider problems. They are also skilled in facilitating the participation of service users in the design and improvement of Health and Social Care Services that they use.

Wider systemic work

Some psychologists work in other ways, where they might focus on the causes of distress as a problem that exists within the wider ‘systems’ that surround a person, such as a family or community. When this is the case, the psychologist will usually apply the same approach of developing a formulation considering these wider systems. These psychologists sometimes work therapeutically with couples, families or a combination of staff and non-professionals. Systemic work encourages the inclusion of different perspectives, where the clinical psychologist avoids positioning themselves as an ‘expert’ who has all the necessary solutions and techniques. Instead, a clinical psychologist working in this way understands their role as facilitating people’s use of their existing strengths and resources.

Other ways of working systemically include working more as a community psychologist. These psychologists are dedicated to developing ways of integrating psychological thinking within a community space rather than in conventional clinical settings. A central part of Community Psychology practice is focussing on social change necessary for the psychological wellbeing of disadvantaged communities, organisations and wider society. If you are interested in the above then you can read online about ‘Systemic Family Therapy’, ‘Community Psychology’ and organisations like Psychologists for Social Change (McGrath, Walker & Jones, 2016).

Research

Clinical psychologists complete a doctorate level qualification which involves completing a novel piece of research over the three years of training. This is often in the format of a larger thesis, similar to a PhD or a number of smaller documents which can be published with less editing. This can be a very challenging part of the training, but it equips clinical psychologists with excellent research skills and the ability to facilitate future research and audit, using a variety of approaches. Clinical psychologists are also in a strong position to share high quality information about treatment effectiveness and Health Service performance to other clinicians or service commissioners. Clinical psychologists may work in research departments at universities and are mainly focused on academic work to advance future clinical practice. These clinical psychologists will sometimes continue to work in a clinical service at the same time.

Summary of roles

Overall, clinical psychologists can use their skills to work in a wide range of roles. As a result, their diverse clinical, research and leadership skills make them highly valuable members of Health and Social Care Teams across a wide range of services. Often, the work of a clinical psychologist has benefits for the broad spectrum of service ‘stakeholders’ who include people using services, their family, partners and the wider community.

UNDERSTANDING THE ROLE OF A CLINICAL PSYCHOLOGIST: MYTH BUSTING

There are several common associations with the term ‘psychologist’ and these misconceptions also relate to clinical psychology. For many people, the specific function of a clinical psychologist generally seems unclear amongst the slang, jargon and stereotypes, i.e. a Freud-like eccentric bearded man sat next to a person lying on a couch. To help provide some clarification on what a clinical psychologist is, it is useful to first bust some of the common myths!

Myth one: ‘clinical psychologists are the same as psychiatrists’

When someone asks how psychiatrists and clinical psychologists differ, a clinical psychologist would usually explain that they do not need the medical training that a psychiatrist would require to practice. Rather, clinical psychologists receive specialist training in psychological theory, research and clinical practice, which includes psychotherapy skills. This training equips the clinical psychologist with the ability to understand and hopefully reduce psychological distress and improve wellbeing by developing a formulation of a person’s difficulties in the context of their life experiences. Fundamentally, psychiatrists often consider the primary cause and method of treatment for psychological distress as biological, involving the brain, whereas clinical psychologists emphasise the importance of psychological and social factors. These factors may include a person’s history and experiences, their relationships and their thoughts and behaviours. Clinical psychologists support an understanding of how these factors can be understood in order...

Table of contents

• Cover Page
• Becoming a Clinical Psychologist
• Title
• Copyright
• Contents
• Acknowledgements
• How to Use this Book
• Key Terms and Organisations
• Introduction
• 1 What is a Clinical Psychologist?
• 2 What is it Like to Train as a Clinical Psychologist?
• 3 What is it Like to Work as a Clinical Psychologist?
• 4 How can I Make the Most of My Psychology Degree and Work Experience?
• 5 How do I Prepare for Applications and Interviews, and Take Care of Myself?
• 6 How do I Know if Clinical Psychology is for me?
• Conclusion
• Appendix: Summary of Charities for Volunteer Opportunities
• References
• Index