The Good the Bad and the Ugly
By a member of in2gr8mentalhealth
I can’t believe it’s been nearly a year since I started my clinical doctorate. People ask me – how is it going? Is it what you expected? I never know how to answer, or even what the truth is.
It is better than I expected, and worse. Sometimes I feel I have learnt vast oceans of knowledge, sometimes I feel I know nothing at all. I’ve had brilliant, beautiful moments of connection, seen people grow, change and heal. I’ve had moments when I wonder if we are doing more harm than good, and colluding with systematic oppression.
I’ve been reflecting on my year so far and my place as a clinical psychologist recently. I think part of what makes me do this is thinking of the parallels with what is going on in my personal life and how that affects me as a trainee.
I believe in the NHS, I think it is a wonderful thing and something to be proud of. But, I’m back in therapy myself, and have chosen to go privately. Partly that’s about time flexibility, and seeing someone straight away (and I am very privileged to have the finances to do that), but part of it is a sense that some people are not helped, do not fit in to the mental health system and can be harmed by it. I also am aware of how it could be perceived by my fellow trainees, teaching staff and colleagues. And I know I’m not being paranoid in my reluctance to be more open.
There’s been several moments in training so far that confirm to me that lived experience is not valued, and actively discouraged. This is something clinical psychology has wrong, and that counselling has right – as a counselling trainee, personal therapy is strongly encouraged, your own live material is used in practise groups and going into training because of your own experiences is the rule not the exception. But not clinical. We are professionals, who could never be affected by these afflictions.
Once, someone in class asked what could cause concerns about a trainee’s fitness to practise, and the lecturer said ‘hmm…something like if a trainee was having thoughts of self-harm?’
I went white-hot with rage.
Thoughts of self-harm?
With that comment, the lecturer has effectively silenced anyone who is struggling and sent a very clear message – tell no one, ask no one for support in case they decide you aren’t fit to practise. As someone who has self-harmed, and still sometimes participates in pretty destructive behaviour (as we all do – don’t tell me you’ve never over-eaten, over-drank, over-exercised?), I’m horrified to think that if someone knew I had a fleeting thought about self-harm it could call into question my fitness to practise.
One of the reasons I am good at and have always been good at creating a therapeutic relationship is I know what it is like to be on the other side. I know what it is like to have intense emptions, to feel out of control and vulnerable. I have so much respect for the people who come to see me, and am honoured by their trust in me, and part of that comes from knowing how fucking hard it is to be in the other chair. I have left therapist’s rooms feeling eviscerated, empty, utterly destroyed and I know what courage it takes to come back week after week. And I have been so, so lucky with the people that I have met and been supported by, that I was helped, not pathologised. I’ve never had a diagnosis, been medicated or been an inpatient, but I’ve been very close to all these at times, and if my life had been a tiny bit different they could have happened.
So many moments so far in training that I have seen poor practise and been unable to say or do as much as I would like to call it out. I feel awful about not being able to do more, but also I am aware of how precarious your position can be as a trainee.
Most of the time, I’m managing to hold a balance. To do what I can, to make the difference I am able to, and know that in the long term I can make bigger changes by being part of the system. To see the positives, and there are a lot. The meetings I’ve been in where psychologists call out bad practise and encourage reflection. The reflective practise groups that help staff keep seeing the humanity in someone who keeps assaulting them. The many amazing support workers, who have such brilliant relationships with service users The families, who have survived such adversity and are still fighting. My very first client, who couldn’t make eye contact with me on the first session, striding out on the last session, head held high, proud of herself and what she had not just survived, but come out of an amazing, resilient woman who takes no shit. An agoraphobic client, who one day walked in and triumphantly slammed down a bus ticket on my desk – they hadn’t left their small town in over two years.
So many little moments, that most days, I think to myself at least once ‘I love my job’. But sometimes, it gets to me.
I hate reading ‘emotional lability’ on notes, when that’s code for has fucking emotions, or is emotional because of trauma, or because we are not listening, or it has been 6 months since they were referred and they have hit breaking point. I am emotional labile! I have emotions that change regularly, as do we all, I’ve just not sat in front of a psychiatrist who thinks that means I’m ill. Intense emotions are part of what makes us beautifully, wonderfully, human. If as a mental health professional, you are uncomfortable with intense emotions, I would politely suggest that is your problem, not the clients.
I hate hearing staff talk about ‘borderline’ people, and use the diagnosis as an excuse to laugh at someone’s distress, to not give them the therapy they desperately need, to call them manipulative when they are just trying to get their basic needs met. When I know full well, that as a woman who is assertive, loud and has intense emotions, it is the diagnosis that I would most likely receive.
I hate that when away with fellow trainees, I actively think about and chose to wear shorts over my swimwear, conscious of the self-harm scars on my thighs.
I try hard to be visible, to speak up when I can, but it is so tiring. And it feels really vulnerable. When we tried to give some feedback to the course about valuing diversity, we were told that we needed to be more resilient and stop being offended. Which to me, said very loudly, shut up. We don’t think there is an issue, we won’t change, and if you keep having problems, clearly it is a problem with you not us. I was disappointed, but not surprised. So I’m shutting up, for a while at least. I need to pass this training to be in a better position to change things.
So what am I saying?
It’s been a mixed year, but I’m convinced I’m in the right place, for the most part. I went into clinical psychology with my eyes open, knowing I would see much that was problematic, and I have. However, I’ve also been encouraged by many professionals and services. In particular, by my cohort, who are calling out, and challenging, and pushing to make psychology what it should be. I have a lot of hope for the future. But it is hard and sometimes feels like pushing an ever increasingly heavier boulder up a hill that I’m not even sure where the top is.
Despite the flaws and my doubts, I wear my NHS badge with pride. I am honoured to call myself a psychologist. I feel that I have found my tribe – the misfit psychologists, those that speak up even if they are slapped down for doing so, that are working, often behind the scenes in a million different ways to try to chip away at the bad stuff and build something better. People that believe we can make this system better. And maybe that is enough.