Looking at the calendar this week I see that I am just a few weeks away from my 10 year anniversary as a Clinical Psychologist. At first I thought it would be interesting to think about what I've learned when it comes to coping with life's challenges. But doing so would have me join the long line of people who have force-fed the world their own quirky life philosophy. So I’ll spare you that little self-indulgent sidebar!
The research is clear on the basics anyway. You should look after yourself physically with a healthy diet and regular exercise. You should connect with people often, take time out to relax, prioritise fun and doing things you love, etc, etc. The Psychological Society of Ireland published a handy information sheet on this. You can access that here.
I am more interested in giving a Clinical Psychologist’s account of what he does differently as a result of 10 years spent trying to support people through tough times. What is it that I do more and less of? Here are a few examples...
Less of this…
- For starters, I spend less time determining whether someone meets official diagnostic criteria from the list of recognised psychiatric disorders. When I first qualified, I spent a great deal of time conducting assessments with an over-emphasis on diagnosis. These diagnostic labels can be useful (and necessary) at times, but I use them more judiciously these days. The reliability of official diagnostic categories has also come under harsh criticism, and the British Psychological Society is amongst those who have expressed concerns around this topic. These days, I try to focus more on understanding a person's difficulties and where they are coming from (e.g., what drives a particular set of problems in the first place). This is something that should be done regardless (known as 'formulation'), but I have more intuitive appreciation of this now.
- Dividing sessions into 'assessment' and 'treatment' appointments. When people come in to see a therapist, most don't want a protracted interrogation about their problems and all the background information required for a comprehensive assessment. Competent assessments are crucial, but I have more appreciation for how it is possible (and more ethical) to provide support in the first session. I mainly do this through education, information and trying to provide some reassurance and hope. Assessment is a dynamic and on-going process anyway (and I am far from being first to say this). It is healthy for professionals and clients to regularly challenge their views of how a problem is viewed.
- Note-taking. Early in my career, I tended to write too many notes when talking with someone. Waaaayyyy to many. I now focus more on listening and attempting to understand. Often when I am taking notes, I am also thinking too much about the next question or topic. A focus on active listening has improved my ability to understand people and appreciate their perspectives (my mind also tends to be less cluttered). So, when talking with someone you care about, think about doing more listening with the aim of improved understanding. Think more about asking clarification questions. Take the pressure of yourself to have answers. These are needed less often than you think.
More of this...
- Focusing on the bigger picture. I spend more time now thinking and talking about a person's difficulties within a wider life context. This can help in identifying a broader range of factors that contribute to problems people experience. Early in my career, I tended to think about a problem in isolation (e.g., identifying 'symptoms'). This made it harder for my clients and I to come up with a range of intervention strategies that were also tailored to individual needs and circumstances. Once relevant 'life' issues are identified, I have also found introducing wider goals into an intervention to be really helpful. This can enable a more comprehensive approach to tacking problems and build on positive stuff such as hope and optimism.
- Emphasis on psychological flexibility. I have come to believe that many behaviours are not 'good' or 'bad'. Instead, the when and the how often of behaviours are key in whether positive or negative outcomes result. Many behaviours are simply problematic because they are over-used. Hiding yourself away from the world for a day may not be a bad thing if you're feeling a bit overwhelmed. But if that's the only way you cope with adversity, life will go downhill. Flexibility is the name of the game. You need a variety of strategies to deal with life, and an ability to pick a strategy that best suits a situation.
- Permission to be a person. In some ways, it is fair to say that I do a very weird job. People pay me, a complete stranger, to talk about the most uncomfortable issues in their lives, and then put faith in me having some helpful suggestions. This can make people feel rightly uncomfortable. Because of this (not to mention the importance of having basic respect for people), I have given myself more permission over the years to be 'myself' or authentic in my professional life. This hopefully make the experience of therapy more comfortable for others (not to mentioned making me feel better about the whole experience!).
As I said above, these are just a few examples of what I do differently now, compared to 10 years ago. Some of these points represent guidance I was given right from my training days. With experience, I have more of a tangible appreciation for their importance.
I am lucky to do this job because I meet so many great people. I think trying to help others is about the most important and meaningful thing you can do in life. I have a whole heap more to learn. Other people have been great teachers so far so I am sure I'll have a lot more to report in another 10 years.