Growing as a Provisional Psychologist

I wrote a while ago about my journey towards provisional registration. I’m now nearly nine months into my 4+2. My 6 month report has been accepted, my caseload is full. I’ve done lots of professional development activities, lots of supervision, and have been reading voraciously. This time in my life is all about career, and about what I want in my career. I’m lucky to be in a position to focus!

A couple of weeks ago, I was at my supervision with Harriet.

We finished a long and productive session, and then Harriet said, ‘I’d like you to do some homework for me this week. I want you to reflect on your journey since provisional registration – not the skills or techniques you’ve learned, but on yourself as a Provisional Psychologist, where you’ve grown and where you’re perhaps ready to start growing more.’ I responded with a smile, ‘sure, Harriet. It’ll make a good blog entry.’

Here’s a bit more of what actually went through my mind:

Capture

I’m pretty sure Harriet is onto me, and if she didn’t read my mind, at least had a pretty good idea of the sorts of things that would be on it.

You see, for a Provisional Psychologist, I am reasonably skilled, experienced and knowledgeable, and I have a history of doing all sorts of things in my work, from supervising mental health professionals, to program development, client-facing work across the lifespan, and all manner of other things. I’ve been working in psychology-related roles with complex clients for nearly a decade now so those are things I’ve been lucky enough to have experience in. Those are all about the work. The work is the easy part.

Thinking and talking about myself, as a Psychologist? This is the hard part.

You see, I have strong perfectionistic tendencies and can be a bit very obsessive at times, not exactly uncommon personality traits in Psychologists given the sheer level of obsession required to be willing to take the time and do the work to register. And despite my robustly good mental health, my resilience has been hard-won and it can be a knock-down mental battle to not say ‘sorry’ more than I need to, to withstand the inevitable judgement of others, or to admit (to myself, and to others) that I’m actually seriously, really truly pretty awesome. And this is after having identified and worked on these challenges from adolescence onward. No wonder I find myself easily relating to the struggles of many of my young clients. I may not have walked in their shoes, but my path has not been so different either, for all that my journey at this point has been 10-15 years longer.

But I digress. On to the task at hand. My development.

What’s changed for me since starting my 4+2? Professionally I’ve continued to build skills, much as I always have. I’ve always read voraciously. I’ve always attended as many PD days and sessions as I can. So my professional development has simply continued on it’s usual trajectory, perhaps a little accelerated as is inevitable given I’ve moved from adult mental health to youth mental health and have had a whole new language to learn, and the time and space to do a lot of learning at work.

But most of my development is about becoming. Becoming what? Why, myself of course.

Before I started my 4+2, I had some fears. I was worried that I could have a supervisor with a radically different view of what Psychology is to me. We’re a diverse profession after all. Given the availability of supervisors, it was entirely possible that I could have ended up with a supervisor with less experience in practice than I have, given my own career journey, or one whose underlying philosophies fundamentally clashed with my own, expressed in a way that didn’t challenge me to think, consider and grow, but rather served to constrain me, limit me, or invalidate me – exactly the things I try to avoid in my work with clients!

I’ve had experiences of not feeling that I can be myself in my work, of my skills and knowledge being dismissed, of feeling that I have had to be less than I am to fit in. And having had those experiences lead to a much greater sense of trepidation about the next step in my journey than I may have experienced otherwise. I did not know if I would be encouraged to be me. I was armed with my knowledge that my actual work role certainly allowed (and encouraged) me to be myself and use myself in my work, and that I have plenty of research to back up my orientation to practice. I knew that I could stay congruent to myself, but I also knew that the right supervisor could be an immense help in my journey. I feel very lucky to be supervised by Harriet!

I find it interesting that my biggest fear in this journey isn’t about my practice, but about myself as a Provisional Psychologist. And what is more interesting is that my growth has mostly been in the intersection between the personal and the professional. I suspect some of that is because I’m really, fundamentally a bit of an existential humanist philosophically – for all that I can talk diagnosis, RCT’s and manualized treatments confidently enough, there’s always been a part of me that’s been more interested in the search for meaning and purpose in both myself and those around me.

Here are some of the key ways I have grown since starting:

  1. I am becoming a little more comfortable in being vulnerable. This is very difficult for me because like all of us, my experiences have helped to shape me. I learned as the bullied ‘fat kid’ in school in the 90’s that to be vulnerable was to be a victim. So I became very good at being guarded as a survival response. I learned to brush off negative comments, to intellectualize, to explain human behaviours in distant, scientific language, to escape into theory. This tendency is actually at times quite useful in Psychology. But not necessarily such a good thing for being an effective psychotherapist because without vulnerability, connection can be difficult. I really started work on this particular journey well before my 4+2, back when I did my grad dip in counselling, and even more so when I started to supervise staff in mental health. It was hard, but I wanted my staff in challenging roles to feel safe, even whilst I also had to sometimes change practice. Doing this required a complete shift in how I engaged at work. I had a gifted social worker as my supervisor when I was team leading, and we’ve stayed friends since – she told me it took ‘a long time’ for her to really get me. I’m more vulnerable/less guarded now in my career than I’ve ever been – it’s taken years for me to feel psychologically safe enough at work to start to do it, and it’s getting easier, with both a fantastic workplace and great supervision. But it’s still hard and it’s still ongoing.
  2. I’m really working to show my imperfections to clients, to really be myself in my work. I work with young people, in an outreach capacity. Part of my role can involve modelling how to build relationships, how to have conversations, share stories, and how to feel safe doing so. This means that for my clients, I need to be able to be less than perfect. I need to be able to show that we all have struggles, and that sometimes these struggles persist, and that it’s ok to have doubts and worries, because we can still thrive in all our imperfect glory. That’s particularly important for me as an ‘authority figure’. So I’ve found myself doing timelines of procrastination with clients struggling with doing assignments, giving examples from my own life (my procrastination/being ‘too busy’ to write up a literature review is coming in handy). Clients and I have practiced conversations using resources such as the Deep Speak cards as question prompts. I’ve modeled courage in revealing myself and my stories for young people who are learning to sit with their own imperfections and fears and engage with the world despite them. Interestingly, I’ve always found it much easier to be ‘imperfect’ around clients than my own supervisors and colleagues. I suspect it’s something about power dynamics.
  3. Before I started my 4+2, I felt a little bit like a psychology outsider. There I was, 9 years of mental health experience, eligible to join the APS, knew many Psychologists through my professional networks, but I never felt very connected to the profession/professionals in Psychology, despite feeling very connected to the discipline of Psychology. Much of that relates to seldom having psychologist colleagues during my career. There are a whole range of things that have made me feel more connected to the Psychology profession/networks. Firstly, of course, was supervision. Finally I had the chance to have the lengthy conversations about Psychology, myself as a Psychologist and my work through the lens of Psychology and not other disciplines (valuable as those perspectives are). Another was joining the APS, and finding myself on the branch committee and being able to get involved with planning events and training. I don’t think I’d have gotten nearly as much out of the APS if I’d not started rocking up to branch meetings and meeting with Psychologists through that. Attending residential college through the College of Professional Psychology has been a lovely way to meet with many other provisional psychologists in person. And finally, being part of groups such as the Australian Provisional and Early Career Psychologists, the Provisional Psychologists ForumWe All Wear It Differently, and EDPNA has been a fantastic introduction to many colleagues both in Tasmania and interstate. I now feel that I am part of Psychology. I’m in the building instead of looking through a window from outside. That helps me to feel more confident.

It’s much easier to think of where I’ve grown then where I haven’t. That’s probably because we don’t know what we don’t know. But here are some directions in which I’d like to grow more:

  • I’d like to become more compassionate towards myself and let my perfectionism become a bit quieter. I’ve managed it in some areas, but not so much in others – usually by challenging myself to think about what I’d think about clients, or what I’d think about people I love. And I think it’s my own perfectionism that is driving some of my desire to be more compassionate, because I know that it what I need to continue to grow in my career. As perfectionism and self-compassion are more or less opposite in nature, I think there’s a tension between the two that I need to resolve.
  • I’d like to continue to build ways of better ‘switching off’ after work. I’m very good about keep my work phone off and not checking emails after I’m finished work or on weekends. I’ve long accepted that my work is a big part of who I am, that I’m someone who likes to spend a lot of time thinking about work, and that I would need to be a robot to never be impacted by the lives of the vulnerable people I work with. At the same time, lots of people I know from different contexts ask me how I fit everything in and whether I actually sleep, and doing my 4+2 does mean additional work and professional development time for me. Food for thought. And there are no easy answers to this one I think. I’ve never met anyone who cares who doesn’t experience challenges.

But what about you, reader? Where have you grown? Where would you like to grow next?

Risk assessment in mental health: So much more than you might think

If you work in mental health, what’s the first thing you think about when the word ‘risk’ is stated? For many of us, the first thing that springs to mind is risk of harm to self. I know that when I have interviewed new graduates for mental health positions, a common area they struggle in seems to be considering risk holistically. We are all trained in suicide risk assessment and management, but not always so much the many other types of risk that we may encounter.

The things that cause people living with mental illness to often have shorter lives than others include so much more than suicide.

For much of my career, I have worked with complexity and risk. I’ve worked with the consequences of when workplace safety systems and risk management fails as a Rehabilitation Counselor, and in my work in mental health programs, I’ve had to consider a whole range of risks in outreach-based sub-acute mental health care, not only to service users, but risks that may be presented to staff.

I take risk management very seriously. I make a habit of reading Coroner’s findings in mental health and any health legal reports I can. When I read Coroner’s findings, I learn about the worst case scenarios that I need to be prepared for in my work. I am a fan of the concept of root cause analysis as a means of better understanding risk.

So, when I think of risks related to clients, I don’t just think about suicide. And whilst I place client need first and foremost, I also consider risks to myself as a practitioner. I currently work entirely with clients with complex and substantial needs, and so risk assessment and management planning in my work role is accordingly quite robust with information from multiple sources and detailed and individualised plans.

These are just some of the things I routinely consider about risk:

  • Suicide risk assessment and management. There are many guidelines that I draw on in my work, bearing in mind that risk assessment is not easy and that suicide risk assessment and management of people from different age groups can have specific challenges. 
  • Risk of non-suicidal self injury. I’m careful to distinguish this from suicide risk and consider appropriate strategies. 
  • Risk of violence / harm to others. We may from time to time work with clients who may become violent. Violence is not limited to forensic work. If you don’t assess this, you won’t know if you need to consider potentially issuing a Tarasoff Warning, consistent with the APS Code of Ethics A.5.2.
  • Risk of harm to self or others because of psychosis. Some symptoms can lead to behaviours with tragic consequences.
  • Risk of harm caused by others. People living with severe mental illness are at much, much higher risk of being victims of violent crime than other members of the population. Anyone can be impacted by domestic violence. What vulnerabilities may the person be living with?
  • Risks related to medical conditions. The gap in life expectancy of people living with severe mental illness is something I find appalling, particularly because at least some of it is attributed to members of the medical profession assuming that the medical concerns of their patients who also happen to have mental illness are all in their heads.

A basic risk management plan for one of my clients will be a great deal longer than this blog entry, and will consider more factors as well. But I hope this summary provides a starting point of things to think about other than suicide risk!

If you ever get the chance, it’s well worth doing training or seeking supervision. In psychology, forensic psychologists frequently have extensive training and expertise in risk assessment and management given the unique nature of their work, but there are professionals with extensive skill and experience in risk assessment and management in a broad range of settings. Some of the most risk-aware professionals I’ve worked in have spent extensive time in public mental health and outreach settings, particularly when they must take ‘all comers’ to their services.

If you find yourself now feeling an immediate desire to learn more about risk and safety, Vicserv are providing outreach safety training for support staff facilitated by Holland Thomas & Associates in February in Melbourne. The training provides information about personal safety in outreach settings and is particularly useful if you are a sole worker. There are often other options that come up from time to time across Australia and many employers will also provide some training – I’ve completed training delivered by Holland Thomas and enjoyed it.

When you have any niggling concerns about risk, always remember there are supports available, such as community mental health teams and crisis lines that work with risk on a daily basis. If you realize there might be some risks in your work that you are unsure how to address, please seek supervision. You could also discuss the ethics of the situation with organizations such as The Ethics Centre. In the event of a crisis (or if in doubt), each state and territory provides crisis services.

The Mental Health Commission lists the following state mental health crisis numbers:

NSW – 1800 011 511- Mental Health Line

VIC – 1300 651 251 – Suicide Help Line

QLD – 13 43 25 84 – 13 HEALTH

TAS – 1800 332 388 – Mental Health Services Helpline

SA – 13 14 65 – Mental Health Assessment and Crisis Intervention Service

WA – 1800 676 822 – Mental Health Emergency Response Line

NT – 08 8999 4988 – Top End Mental Health Service

ACT – 1800 629 354 – Mental Health Triage Service

And in an emergency, dial 000 for police and/or ambulance.

 

By Ceara Rickard 

Ceara Rickard is a mental health professional with diverse professional interests, including adult and youth mental health, the consumer movement, career development and professional ethics. She has extensive experience in program development and management, mental health, and working with mandated clients. Ceara holds membership of the Australian Society of Rehabilitation Counsellors, Professional Membership of the Career Industry Council of Australia, Associate Membership of the Australian Psychological Society, and registration with the Australian Health Practitioner Regulation Agency as a Psychologist with Provisional Registration.

After Psych(Hons): Developing a career in mental health

By Ceara Rickard

It’s that time of year again where psychology students receive their end of year results and are forced to consider their professional futures in a far more immediate sense than they may have needed to during their first four years of psychology education. It can be a pretty difficult time, given that it’s not very easy to become a registered psychologist after completing 4th year, with two years to go in education or placement before one can register. The Psychology Board of Australia (PsyBA) specify three pathways towards gaining general registration as a psychologist, each involving at least two years of registration as a provisional psychologist.

None of the options are ‘easy’ and each bring their own specific challenges. The journey to psychologist registration can be a long and winding road. Perhaps learning about my journey may help you to consider yours. But my journey isn’t really about becoming a psychologist. It’s about developing a career doing what I love.

A while back, Dr Boris Fedoric introduced me to the Chaos Theory of Careers and wrote about his fascinating journey. The theory is also illustrated very well by my own career journey.

We live in a fast-paced world, where change, chance and complexity are inevitable. Whilst it would be very pleasant for us to be able to accurately predict every step of our career journeys, the truth is that it is impossible to predict and control everything. So, for the last 15 or so years, I have wanted to become a psychologist.

When I was in high school and undergrad, I thought my career journey would look like this:

That is, of course, not what actually happened. I finished Honours in 2006. I am now, finally, registered as Psychologist with Provisional Registration, working through my 4+2. My career journey has not been the straightforward process I thought it would be at the age of 16.

Before writing this blog post, I thought about what stories to tell about my journey. My journey towards Psychology has not been a linear process so I can’t tell just one story about my career. So here are a few plot lines. There is the story about a third generation welfare recipient going to uni. There is a story about wanting to do a Masters degree for nearly a decade and not getting there. That one is more a comedy than anything, with a sub plot about being a hapless pet owner! There are the stories of my colleagues, managers and clients and how they have influenced me. There are also the stories about how my family, my relationships, and my friendships all influenced my career choices and options. There is even a story about the direct influence of government policy on my career. There is the story about a wonderful journey of self-discovery I have been on as a mental health professional. It’s also a story about values and choices. It is a story about how I learned to stop worrying and embrace change, uncertainty and unpredictability. Ok, that’s a lie. I’ve just learned to accept that worry is part of life and that it’s not really anything I need to, well, worry over.

This is a little of what my journey since completing Honours in 2006 actually looks like. Don’t panic. My story is a good one. Start at the top left and follow the lines. Don’t worry if it confuses you. Looking back, it confuses me a little too. But that’s a large part of what has made it useful.

Here are a very few of the things I have learned professionally in taking the path I have taken:

  • Relationships come first. How I engage as a professional is more important than what therapeutic modality I choose to use. This is not only something I’ve noticed from personal experience. It is also consistent with the literature. In my work, whilst I am ever mindful of appropriate professional boundaries, I have learned that I need to know myself, be myself, and use myself to be effective, and I bring my own personal style into any work that I do.
  • Psychology is one of many disciplines, all of which have different approaches and theoretical orientations, and all of which have unique strengths. Working with diverse clients in a multi-disciplinary environment has been one of the best career choices I have ever made.
  • Registering as a Psychologist is not nearly as important to my ability to have gainful employment as I believed when I was a new grad. I can have a career I love whether or not I were to ever gain general registration and there are a whole range of qualities that effective therapists have that should and do exist in Psychologists, but also often exist in many other mental health professionals.
  • Psychology was definitely the right choice for me professionally, and my Psych Hons degree has given me a wonderful foundation for other learning. The critical thinking, emphasis on evidence-based practice and diverse knowledge base of Psychology continue to appeal to me. That is why I’ve continued to move towards registration, despite my winding way of getting there.

What I have learned personally in taking a less straightforward path:

  • It might be a platitude, but I truly believe the journey is more important than the destination and now I know this from experience, and not just reading Robert Frost poetry.
  • I have learned how to (mostly) leave work at work and accept ‘imperfection’ in myself and in my clients.
  • I have learned that I will never know everything, I am not a perfect practitioner, and never will be. No one can be. And that this is ok. I am enough.
  • I have learned to embrace the fact that I am a massive nerd, and that I continue to read at about the same rate that I did when I was at university – not because I have to meet minimum PD requirements for some of my registrations, not because I have assignments to do or will be performance managed if I don’t, but because Psychology is much more than a career to me. Mental health is an enormous part of my identity.
  • I have learned more about my own values, and how these impact my choices, both professionally and personally.

The challenges in my career journey have had an enormous impact on my work, and a positive one. I would be a different person, professionally and personally, had I followed my original plan, but not necessarily a better one.

If you are not happy with your results, or miss out on that treasured next step in your career, whatever that may be – take heart. Your journey is not over.

 

About the author

Ceara Rickard is a mental health professional with diverse professional interests, including adult and youth mental health, the consumer movement, career development and professional ethics. She has extensive experience in program development and management, mental health, and working with mandated clients. Ceara holds membership of the Australian Society of Rehabilitation Counsellors, Professional Membership of the Career Industry Council of Australia, Associate Membership of the Australian Psychological Society, and registration with the Australian Health Practitioner Regulation Agency as a Psychologist with Provisional Registration.