Reflections from DClin applications

Denisha author credits &   Sam author credits

Assistant Psychologists around the country tend to go underground between September and December each year, as this is the hallowed window for writing applications for the Clinical Psychology Doctorate. You get a whole 3,000 characters to send to a maximum of four universities to explain why you’re amazing. It’s a tough process, and a process that the majority of applicants will go through more than once. Since we’ve been a bit quiet throughout this process, we wanted to reflect on how it went this time round…

Sam

Having done this form before, I thought this year would be easy and significantly less stressful, but I think I’m starting to realise that that’s probably never going to happen…

Working within the NHS in a small team made up of assistant psychologists can be both a burden and a curse throughout this process. While being surrounded by other people going through the same nightmarish ordeal as you is comforting, it’s important to ensure it doesn’t become all-consuming. When you’re in the middle of applications it’s so easy for it to spill into everything you do, both at work and at home. In our office we found that actually making sure we had conversations that were a million miles away from ‘How’s the form going?’, was vital for our emotional wellbeing. Also remembering that although your colleagues are technically your competition, that comes second to your current relationship with them. Denisha and I share an office and I like to think we’re pretty good friends, that will always come over and above any competitiveness from trying to get on the same course. I’m not a competitive person by nature and I learnt pretty quickly that competing with colleagues within clinical psychology would always be a waste of time. You’re trying to do the same thing, big deal, so are most people in most careers in the world. Sure the doctorate is a little different because you get one shot each year and the uncertainty surrounding the funding makes people more desperate to get on as soon as possible. However, if you let that competitiveness poison your working relationships, the road to get on the course will quickly become a lot harder and a whole lot more lonely. I’ve heard horrible stories about AP’s falling out over this process, and managers even having to step in to resolve office conflicts. I can gladly say I have never experienced that, and I hope it’s not something I ever come in contact with. It can be super difficult working with lots of people all shooting for the same thing, but it’s not going to change until you get on the course so you might as well make the best of it and help each other through. After all, misery does love company.

One thing i remembered from last year that I carried into this years’ process was that absolutely everyone will ask if you’re applying. Everyone knows an AP post is a step up to the DClin. We aren’t paid remotely enough money or given enough responsibility for this to be your final career stop. Everyone is doing this for the experience and then they either get on the course or move on to another post. So naturally, managers/supervisors/everyone-you-come-in-contact-with-who-has-worked-in-NHS-psychology-for-more-than-5-minutes is going to ask if you’re applying, offer advice or even offer to read your form. Last year I found this overwhelming and at times almost invasive, which I am well aware was not anybody’s intention. In the caring profession, you’re surrounded by people whose job is to help others, and so they want to nurture you and support you through this god-awful process that usually they’ve had to suffer through themselves. Being aware that this was going to happen made me more prepared this year, I didn’t feel as overprotective of my form as I did the first time around, and I was able to constructively use people’s advice and comments to (hopefully) improve my application. If you’re a first time applicant in an NHS setting, be aware that this is likely to happen, but try to appreciate and utilise the support effectively, trust me it’s a godsend.

Having left the form writing to last minute last year, I vowed to be different this time around. I wanted it complete and ready to send by the end of October, especially since I was having a three week holiday in November and arriving back in the country three days before the deadline. This absolutely did not happen. I was manically making changes to my form on an airplane flying 30,000 feet across the sea in an effort to eventually get to a point when I was happy with it and ready to send it off. And then I realised that actually, that is never going to happen. It’s never going to feel perfect and you’re probably never going to feel ready to let go of it. There is a comfort in editing; feeling like you’re making it better and you’ll eventually make the change that will get you on the course. I honestly believe that the hardest part of this application process is the end. Working for three months on 3,000 measly characters is both emotionally and physically draining, but at least you’re working on it. Submitting it should bring waves of relief but I have found both times it’s just bought more anxiety and it’s taken a good few days to get to a point where I can get it off my mind. It’s something that you just have to manage, I am constantly working on my ability to sit with uncertainties both at work and in my personal life so this has just become another challenge I need to tackle. It’s nice that it’s gone, I don’t have to stress about it every evening when I get back from work and a general calm has taken over the office for the time being. It won’t last, the buzz will be back in February when interview invitations start to go out but for the next couple of month’s ignorance is bliss and we all get to pretend it’s going to be good news. I think reflecting on this process is really important because of how emotionally draining it is, making sure that you’re still good and you’re still happy when you come out the other side is just as important as making sure you’ve got a good application in. At the end of the day, it’s only work right.

Denisha

It’s been a week since the application for the Doctorate in Clinical Psychology submission due date and I am not sure how I can describe my feeling towards it, but I’ll do my best.

My initial reaction after submitting the application surprised me. I expected to feel relief, however I actually felt a lot worse. I instantly began to doubt the 3000 characters I had expressed to summarise and reflect on 6 years of experience. I began beating myself up about once again not leaving enough time for reviewing and gaining feedback and believing that more time would have led me to feel more confident in my submission. I had submitted a day earlier than the due date as I was aware that I would not have time on the Wednesday for submitting as I had to help plan a conference, which was to follow on the Thursday. This also meant that I felt that I could not dwell on my feelings of distress towards the application since I had to focus my energy on the conference. I avoided any discussion of the application and asked my friends not to mention it until March when I would officially hear about interviews (however as we tell many of our clients “avoidance is not always a helpful coping strategy”, hence I’ve decided to share what I have learnt from being involved in the process).

What I learnt from the application experience:

  1. You will never quite feel satisfied that you have managed to illustrate why you are the best candidate. This is an uncomfortable feeling, but a feeling that you begin to get used to and eventually let go.
  2. Leave yourself enough time for feedback and redrafting. I created about 8 drafts before I felt confident in allowing anyone else to read it. The application is about why you personally stand out and I guess by allowing people to criticise the application you are opening yourself to criticism about personal characteristics. On reflection, I would allow myself to criticism a lot earlier in the process. I had left it too late and then became confused as to what was good and what needed more work.
  3. Try not to get too attached. Whilst the application is about why you personally would be a good candidate, people will often criticise the way you have written something or that you have undersold yourself in a particular area etc. It is useful to remember that whilst at first this criticism can be tough to hear, people that know your strengths are trying to help you illustrate these in the best way possible.
  4. Allow a range of people to read your application. I gave my application to a few clinical psychologists, a friend and a trainee. Each person who reads the application will have a slightly different perspective, but will also reflect on what they know about you in respect to the relationship they have with you. A friend who knows you outside of a professional setting will be able to help you when it comes to illustrating your personality and passion. A trainee can help you think about recent agendas within the training courses. Clinical psychologists, (I’m sure I do not need to say this) are useful for reflecting on your professional development and how well you have been able to illustrate this.
  5. Take care of yourself. You will spend your weekdays, your weekends, time in the shower etc. thinking about sentences that could be used in your application. It can encompass much of your thinking space, but it is important that you take a break. I found it useful to take time away from the application and become involved in an activity outside of psychology. When you spend too much time thinking about the application, it can be quite overwhelming and can leave you with feelings of stress and anxiety. Time out from the application allows some breathing space and can refresh your mind for when it’s time to think about it again.
  6. Support each other. It can be a difficult time to work within a team of assistant psychologists. The topic of conversation from September onwards tends to be about the application. “Are you applying this year?” “Have you started on your application?” “Have you given it to anyone yet?” There always seems to be an element of competition and feelings of anxiety and panic begin as you compare your application activity with the others around you. I think it is important to recognise that supporting one another, especially in the working environment can really make all the difference. The application is a reflection on how well you can reflect and summarise your experience and therefore helping and supporting others either with their application or the stress elicited by the application will not be detrimental towards your chances. They’re also the only other people that can understand the process as well as you.
  7. Reflect on what made you go into a career in Psychology in the first place. It is difficult to remember the values that attracted you to Psychology but reflecting on this at the beginning can be a useful way of thinking about what matters to you. Linking your personal values with the competencies and values of the practice of a clinical psychologist is a good start.
  8. Try to think about what makes you a good candidate that differs from the basic or essential criteria. The courses can get up to a 1000 applicants a year and many people will try and illustrate what they think people want to hear rather than reflecting on their actual strengths. It can be quite easy to only reflect on what previous applicants have reflected on, or what the personal specification suggests. However, if you can identify strengths that make you stand out as a psychologist, you are more likely to capture interest.
  9. Give yourself plenty of time to contact possible references. References are important and you do not want to decide these a day before the deadline just in case they are on annual leave, unavailable or are unable to write your reference for other reasons.
  10. Pat yourself on the back and treat yourself. Writing about your achievements in 3000 characters is not an easy process and can be a skill in itself. If anything, it is a useful process to acknowledge all the work you have done and how it has developed you as a person and a psychologist.

Moving forward in clinical psychology: A focus on psychological therapy models for people from non-white backgrounds

Denisha author credits

I feel like we’ve travelled back in time. Since the announcement that the UK was going to leave the EU, there has been a rise in racist attacks.  Unfortunately, these attacks do not seem to be exclusive to the UK, but in the USA there have been multiple examples of men from black backgrounds being shot by white policemen.  This has given rise to protests standing against discrimination see #blacklivesmatter.    I say that we have travelled back in time, because similar protests demanding fair and equal treatment for black people were happening around two-three decades ago.  In countries which are economically and technically advanced, it is frightening that people from black and ethnic minority backgrounds still do not have fair and equal treatment and that some people’s perceptions around difference are still infantile.

The media do a very good job at emphasising negative events causing more anxiety and fear.  Hearing that the majority of England voted to leave the EU based on wanting to “get rid of immigrants” does elicit feelings of anxiety in me.  I feel unsafe and feel like I need to go round holding up my passport in front of my face to defend that I am British, was born here and have no other country that I would consider my home.  I feel safer in London, which is enriched with varied languages, faces, dress sense, cultures, social backgrounds, economic backgrounds and experiences.  Whilst we all have differences, we need to acknowledge that despite these differences we have universal similarities that make us human.  Pain, suffering, happiness, fear, shame, excitement, love are all concepts that we can all understand, that we can all connect with.  We should not be fighting one another, but embracing in these similarities. Unfortunately our society is created in such a way that so many people are oppressed by authoritative systems and find power by projecting their suffering to other people and causing others to suffer.

I would however like to dedicate this post to some movements happening within clinical psychology around diversity, to illustrate that there are people in the UK who support and celebrate difference and who are working very hard to enable the needs of diverse communities to be met and heard.

Psychological therapy is misconceived as being for “white people”, this is problematic in that people from black and ethnic minority backgrounds are more likely to be prescribed medication, be admitted to mental health wards and not access services.  Some mental health services are making efforts to ensure individual and group therapy sessions involve interpreters where possible and those who refer people to psychological services are aware that services do use interpreters and that all cultures and races have fair access to therapy.   An additional problem is that psychological models used in psychological therapy are based largely on Western culture and concepts, whilst elements of these models will strike a chord with people from diverse backgrounds, there are many factors that have a large influence on wellbeing and psychology such as culture, religion and spirituality that will not be covered. Thus more work needs to be done to create ethnocentric psychological models.

Here are a few of those models (please note some models are not evidence-based yet and are proposals):

Hilary Garraway’s Adapted Cognitive Behavioural Therapy (CBT) Model

During a psychological assessment, the psychologist/therapist will likely ask questions that cover social factors, biological factors, environmental factors and cultural factors. However very rarely will a psychologist/therapist ask about religious or spiritual factors.  If the questions are not asked, it is unlikely that the person in therapy will disclose these aspects of their lives. Even when they do, if the therapist/psychologist has little knowledge/awareness around these aspects they will not be discussed very well.  Garraway’s holistic CBT model incorporates Spirituality, where unhelpful and helpful factors are discussed.  Reflecting on my own experience as a British Indian, my spirituality has influenced my thoughts, feelings and behaviour in helpful and unhelpful ways.  Praying in a Hindu temple is a helpful behaviour for me because I feel calm, safe and peaceful.  It allows me to have time for myself where I can reflect on everything in my life I am thankful for and takes me away from the busyness of day to day life outside the walls of the temple.   My spirituality has also caused some conflict for me.  Working in a field that considers itself scientific has been difficult.  In the Western world, there is the idea that science and spirituality or religion can not exist in tandem.  This caused inner conflict in me as for me science and religion did exist in tandem but the society that I lived in did not accept this. This conflict may not have been completely apparent to me and may have been projected as symptoms of distress.  It is helpful to have these discussions with a psychologist as treating symptoms of distress are a temporary fix, without acknowledging the conflict that has led to the symptoms of distress, a person is unlikely to fully recover.  I like Garraway’s model as it really examines what is important, helpful and unhelpful at an individual level.

garraway cbt

Figure above:  Garraway’s holistic CBT model

 

A culturally adapted intervention for postnatal depression in British Asian women (ROSHNI2 trial; Masood and colleagues, 2015)

This randomly controlled trial (RCT) looked at culturally adapting a CBT model commonly and effectively used for treating postnatal depression.  The intervention enabled better access to therapy for British Asian women.  Some barriers to accessing therapy included childcare, access to transport and language.  The intervention provided childcare, transport and facilitators of the group intervention were bilingual, speaking English and Urdu.   The factors that elicit depression within the South Asian population is likely to have some differences to a white population. For example the women that took part in the therapy were from a Pakistani background.  It is common within this background that women may only leave their houses if they are accompanied by their husband or another family member. This is likely to have psychological impact to the woman, in regard to self-esteem and confidence.  Other factors may include social isolation, language barriers, unemployment.  The therapy sessions looked at pressures and expectations of Pakistani women, examples of depression, understanding and managing self-esteem, envy within and across families, religion and spirituality, pressures of looking good.  Many of the themes were targeted at looking at common issues women of a Pakistani background face.  The intervention was effective in increasing well being.

Blackness Centred Compassion Therapy (in development) (Guilaine  Kinouani)

This model proposed by Guilaine Kinouani adapts compassion therapy.   It considers a person’s ethnic and ancestoral history along with the psychological impact of shame.  Shame is an important psychological concept in many ethnic communities and is something that is not widely discussed in Eurocentric approaches.  The shame experienced by many people from ethnic communities is usually wider than on an individual scale, for example as an Indian, my parents would explain that “bad” behaviour would bring shame to the family inflicted by the wider family community.  The shame discussed by Guilaine, is one experienced by people from a black community in regard to feeling ashamed for being black in a white community.  Again, the shame is a bi-product of not fitting in with the expectations of a larger community.  The model incorporates acknowledgement of race-based shame in relation to a personal and historical context.   Coping mechanisms to deal with this shame are also examined.

I would advise that you read more about the proposed model on Guilaine’s blog Race Reflections.  The model is well explained connecting psychological theories and concepts with experiences of being black.

asiancbt

Psychology therapy sessions aim to create a safe space for people to be completely honest and disclose inner secrets, conflicts, desires that are rejected on a wider basis.  However, if the therapist/psychologist is not willing to listen and acknowledge aspects of experience and identity that involve protective characteristics such as race, gender, sexual orientation, disability, etc. then they are only doing half the job.  Talking about protective characteristics and people’s experiences in regard to them are silenced within society.  Talking about discrimination makes people feel uncomfortable.  If therapy reflects this, then it is not going to be effective for people who identify with diverse protective characteristics.  The models discussed above are a good start for allowing people the space and opportunity to be heard and talk about issues that society has prevented people from talking about.

All the news is awful

 

Sam author credits

We’ve been trying to decide what our first blog post would be for a while now, we were hoping to be able to comment on a nice uplifting news article or new piece of research – something positive so we’d get off on the right foot and wow you with our psychological prowess. But actually at the moment, all the news is awful. So instead of trying to wait for that silver lining comment piece, I thought it would be better to practice what I preach and avoid avoidance by talking about everything that’s going on right now. And I don’t want to get too political here – whatever your views on the recent Brexit vote, or who should be the new Prime Minister, or whether gun laws should change are yours and yours alone, this blog is not designed to be a platform for political debates; what I’m talking about – and maybe this is just me, but the general sense of hopelessness and powerlessness that seem to be emanating at the moment as a response to everything that’s going on.

Although the EU referendum vote in itself was in our control, but personally I’m not so sure we as ‘lay people’ (for want of a better word) have the credentials to make such an important decision about our country. It was evident from the most popular google search the day of the announcement being “what is the EU?”, that actually, we probably weren’t as equipped for this vote as we should have been. Don’t get me wrong I know there are huge amounts of the population that were thrilled with the outcome, and that’s good because they exercised their voice which we are all entitled to do. However a lot of the electorate have been left feeling either duped for relying on statistics which have turned out to be falsified claims, or disappointed that despite their vote, we are still leaving the European Union, a dramatic change with repercussions and consequences nobody can be certain about. (Quick disclosure here, I was one of those latter people). Since the outcome of the vote it’s sort of felt like a lot of the UK’s stability is crumbling a bit, and that insecurity can lead to powerful feelings of hopelessness, despair and grief. It is as though we’ve lost something in all of this. Following the vote a huge number of politicians quit, which immediately led to a feeling of instability at a time when we need a strong leadership to navigate the way through these changes. Additionally the outcome of the vote has led to an increase in racism and xenophobia – or maybe just a more vocal increase in people’s already present feelings; it’s almost as though the country voting to leave (by a tiny margin might I add) has made discrimination and prejudice okay again, it feels like we’ve taken ten steps backwards.

Being an assistant psychologist in an office of assistant psychologists, and ever the optimist, I immediately tried to formulate this process with the help from my other AP’s. We found that a lot of what we’re experiencing can be explained by the Kübler-Ross change curve, a psychological model developed in the 1960s by Elisabeth Kübler-Ross. It was origionally designed to explain the grieving process, hence why it bears such similarities to the widely known “5 stage of grief” model, but has since been used to understand and explain reactions to significant upheaval or change in a person’s life, and the impact this is likely to have on their daily capabilities and performance.

Kubler ross model

The Kubler-Ross change curve (photo credit google images)

 

I think shock was a common experience for most people following the vote, whichever way people voted ; I think the remain people were surprised that we actually left, but also a lot of the leave voters were also surprised by this as most of the exit polls had indicated the vote going in the opposite direction. The flurry of petitions to re-run the vote, or even try and keep London as part of the EU because of its overwhelming majority voting to remain, demonstrated the denial that people are experiencing which again is explained using this model.

A couple of weeks on, the mood has moved more to frustration and depression, with remain voters coming to terms with the fact that this isn’t a decision that can now be changed. People genuinely seem to be having a really tough time with this change, and according to a recent news article Psychologists are reporting higher incidences of anxiety, difficulty sleeping, lack of appetite and low mood related to the vote outcome, and mental health referrals have already increased. In the wake of the vote results being announced we have had swaths of politicians leaving their posts because they do not support the decision that has been made, and even by those who were supporting this outcome, which has led to further public frustration and uncertainty. There have also already been a lot of withdrawals of promises from the leave campaign, most notably the quick U-turn Mr Farage made on the claim the extra money we will save (£350 million) would be going to fund the NHS. Due to this, the frustration is not only within the remain camps, and the Independent reported that of the 17.4 million people who voted to Leave, 1.1 million of these now wish they had not done so.

The depression is evident, but it makes sense, people are mad and they’re scared, they’re not ready to move on yet and acknowledge the new reality. Often we hunt for a scapegoat we can pass the blame onto – something tangible that anger can be aimed towards to make them feel better, which is evident at the moment with the hate for the government and marches taking place particularly in London. Morale is very low and this isn’t a change we’ve experienced before so nobody is quite sure what happens next and that uncertainty is keeping people from moving forwards. However it won’t remain this way forever, people will move forwards and into acceptance and integration of this new reality. The final phase of the change curve involves experimenting with the change, trying it on for size and seeing how it fits in our world, which will come in time as the outcomes of this result become more clear and understandable, and this will be followed by acceptance and a gradual improvement in morale, we just have to be patient and allow it to be processed.

I like this model. I think it’s useful in situations like this for people to be able to see how their emotions are likely to progress. It’s important to note that although stage 1 then 2 then 3 is the most common way of travelling through the curve, there isn’t a right or wrong passage and some people may find they don’t follow the same track as others, and each do so at their own speed. The value in models such as this is providing hope and direction when people are feeling lost, they show that although you may be feeling quite depressed at the moment, it’s okay because it’s going to get better, and challenging your cognitions about the change that causing these emotions will help you improve your mood and develop in a positive direction.

Change is scary, but there’s no escaping it. And big changes, whole country changes, will always be daunting because it makes us feel small, but it opens discussions about powerlessness that I think are important to have. I work on an acute psychiatric ward and I was sat with a few of the service users in our activities room the week after the Brexit vote discussing how London as a whole had voted in and so many people were disappointed that we’d left, and one of the patients just said “people are annoyed that a decision has been made that will affect them and it’s not what they wanted, well now they know how we feel when we’re held under a section”. It was powerful, and it’s something we will absolutely be coming back too in another blog post soon.