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?

The power of peer self help support groups

Healing in the Everyday World: The benefits of peer self help support groups and their place in the therapeutic process towards recovery…

by Tabitha Dougall

Twenty years ago, as a new mum, I was struggling with (what felt like) atomic fallout left over from unresolved childhood abuse and complex family relationships that were collateral damage because, like most people, the perpetrator was known (from within my family) and there were mixed loyalties, ineffective coping mechanisms and no justice or resolve.

One Christmas time (when issues/feelings are often the worst), while driving I felt like crashing into a tree and ending it all, so instead I drove to my GP to get a referral to a psychiatrist. My  well-meaning GP asked why I was struggling, and told me “Christmas is a time for forgiving and forgetting” and I needed to move on.  I told her I’d spent 25 years trying to do that, and it didn’t work, and re-iterated my request for some professional support, now feeling further invalidated and unsupported by her dismissive response.

The psychiatrist was helpful with some other issues but didn’t seem to really know what to do about trauma so left that alone, and it festered.  (Many therapeutic professionals have actually had no trauma-informed training).  A few psychologists later (who were helpful to a point but traditional Cognitive Behaviour Therapy approaches don’t go deep enough or address the body, mind, emotional, soul, stigma and inner isolation issues) and I found myself borrowing everything I could find in the library about healing from trauma.  This ‘bibliotherapy’ was helpful and gave validation and a range of different approaches… and one book suggested that peer self help support groups could be helpful.

So began a journey that changed the course of my life.

Now, twenty years later, I work at a not for profit organisation part time overseeing recruiting, training and facilitation of volunteer support group facilitators and have my own private practice as a holistic counsellor. I’ve undergone a comprehensive cleansing and healing of my past with many resources suggested by support group peers.  Over the past few years I’ve been involved with training and supervising a few hundred potential self help facilitators and helping many different types of support groups start up. This all developed from a daring decision fifteen years ago to start up a support group for women survivors of child abuse, with no training or experience, just a passion and a need, and a little support from my counsellor at the time.

Why should people attend and/or run support groups? 

Self help peer support groups are opportunities for small groups of people with a similar issue to voluntarily come together on an ongoing, regular basis for mutual support, empathy and encouragement.  They are generally peer-led, democratic, with open membership (people can come and go as they need) of between 2 and 20 attendees.  There is a strengths-based, normalising, de-stigmatising philosophy rather than a pathological, problem-patient vs expert-professional approach, and they are free or low cost as opposed to fee-for-service which makes them accessible to all.  Guilt, shame, confusion, alienation, fear and disempowerment can all be discussed, unpacked and worked through in the non-hierarchical group process and over time, replaced with empowerment, connection, normalcy, agency, self-responsibility, inner peace, self esteem, self respect, inner  strength and increased social skills. Members of the group are seen as equals and experts in our own recovery journey while a broader perspective of our issues can be gained from various viewpoints and experiences of other group members and modelling from others who are further along their recovery path.  Perhaps one of the most profound benefits is when we can adjust our self-view from one of victimhood, to one of ‘helper’ where our feelings, experiences, opinions, skills and qualities matter and can make a difference to someone else. Helping others helps us feel useful and valuable, like we have something to offer to the world, altruistically increasing our sense of purpose.

It has been said that there are two important qualities that foster great mental health – purpose and connection; both of which can be enhanced in the process of contributing in support groups.  We can feel less dependent and become more active in our own healing and in assisting others.  There can be a sense of hope and a new supportive community.  Support group attendance can be a stepping-stone and adjunct to professional help.

Group guidelines/norms provide a sense of trust, emotional, psychological and physical safety, usually involving respect, non-judgment, confidentiality and no advice-giving.  These can often model new and assertive ways of relating in the outside world as well.  Group members are encouraged to share experiences and feelings and talk through their thought processes, often challenging previous secrets and shame-based stuckness while being deeply heard, understood and validated.  Often this in itself is enormously healing.  Humour from within the peer setting can also bring a certain lightness that may not be available or accessed in a professional therapeutic relationship.  Other perspectives from within the peer setting can also be easier to hear than if coming from a condescending stance which can sometimes happen in therapy, or in families.

Yalom said: “we are separate, lonely, apart from but also a part of.  One of my members (of a group) put it elegantly when she described herself as a lonely ship in the dark.  Even though no physical mooring could be made, it was nonetheless enormously comforting to see lights of other ships sailing the same water.”

There is positive research on support groups’ efficacy and they are found worldwide. So why, then, if support groups can be so helpful, are they not on every corner? Why are they not included as an important part of professional therapeutic case-management? Why are support groups not recognised, acknowledged and referred to by GPs and mental/health practitioners at least?  Not known about? Not widely funded?

Some health professionals may be of the opinion that support groups are just ‘whinge-fests’ and there is no positive movement.  My experience has shown that sometimes progress is slow, and we need to check our own impatience with others who aren’t changing to our assumed goals and timelines, however many group members have experienced compounding rejection from families, friends, workplaces and therapists and the safety they find in support group settings is the first/only time where they can feel unconditionally accepted, and it is in this kind of environment where deep healing can occur.

People with lived experience as well as health professionals can all be trained to successfully run self help groups.  In the current climate of limited funding for mental/health, self help support groups can be a valuable budget-friendly addition to ANY service provision, offering ongoing support to a wide range and number of people, both in the bustling cities and in the resource-poor regional areas, and offering the opportunity to grow, develop and re-invent oneself.  Visit the Collective of Self Help Groups (COSGH) and/or visit the Centre of Excellence for Peer Support for more information.

About the author:

Tabitha Dougall is a Holistic Counsellor, Psychotherapist and Group Facilitator with lived experience. Based in Melbourne, Tabitha promotes healing & authenticity through creative expressive modalities alongside talking therapy. She draws from broad life experience & her own healing journey, over 20 years of personal and professional development, volunteering & coaching others, and 15 years group facilitation.