On the imposter complex

On the imposter complex

Hello ūüôā

I’ve been busy! I got a new job, I moved house, I had a dramatic hair cut. Things are pretty good for me now, and I think I’ve had less to write about because of the new environment I work in.

I work in a community psychology service, and it is the dream. It has been unbearably great to be surrounded by clinicians who are ethical, considerate, skilled, and who are interested in my own development. It’s still very stretched, underfunded and staffed, busy and hectic and challenging, but I feel far more comfortable with the ethos and don’t feel like I’m constantly witnessing difficult and sometimes dangerous practice happen on a day-to-day basis. Which is nice!

I do, however, feel like I’ve been given this job in error, despite having been here for 4 or 5 months now. Ding ding ding here’s the imposter complex! I feel as though I have no idea how actual therapy works, and theories and models that people use in casual conversation are alien to me. Once I got to know the other assistants a bit better, they shared that they felt the same, which was so normalising and a real comfort to hear. I now realise that this is something many people experience, so thought I’d share my words of wisdom on how to deal with this here, in case any readers stumbling across this post have similar worries. My remedies are 1) Reading, 2) Supervision, and 3) Keeping Track and 4) Parental Wisdom.

Reading

I put this one ahead of supervision for several reasons. First, because it is something that I can do on my own, in my own time, and at my own pace. I felt more comfortable taking my worries to supervision once I knew I’d done a bit of work myself. And it makes sense right – I’m working in a new area/client group, so why on earth WOULD I know all of the background info unless I read up on it? Reading and studying a bit feels natural; it’s what I would do at uni if I didn’t understand something, and it’s something I know I am good at doing. It’s familiar. So I had a decent read, and made a mental note to schedule in a few hours a week to keep doing so – either reading new stuff, or going over the core stuff until it felt more consolidated. This made me feel much, much better.

Supervision

Super important. I had a read, I got a grasp on the basic literature in the area I now work in, I properly digested the stuff I’d read in a frenzied 3am pre-interview panic. This made me feel like I could go to my supervisor and offer what I did have at the same time as admitting what I didn’t. I shared that I felt a bit like I didn’t know what I was doing, and that my colleagues perhaps thought I might know more/have more experience than I do. I present pretty well in interviews and apparently also in observed clinical work, which is good (I think!?) but I think this can make the gaps and needs I have less apparent, meaning I need to bring them up more explicitly. I have been blessed with two absolutely bloody fantastic supervisors, who I am now completely open with and who have been endlessly helpful so far. I’ve always been the kind of person who has no shame in asking when I don’t know something, but there was something about not wanting to make them think they’d recruited the wrong person or that I was desperately inadequate that made me feel nervous about bringing it to supervision. Well, top tip: do it. It will make you feel better. It will become a topic you’re comfortable talking about, and you will develop far quicker than if you muddle along thinking you’ll get fired if you admit that you don’t really understand that particularly fiddly bit of that obscure model that your supervisor loves, or what an ANOVA actually is even though you have had three years of stats teaching. Honestly. ūüôā

 

Keeping Track

I am a chronic diary writer, so it made sense to really keep a track of what I was doing and learning at work too. I did this anyway, at first not really in an effort to assist with the imposter complex, but boy was it unintentionally helpful. It was with great delight that when I looked back over a 16 session piece of work I completed with a service user, I felt like I could see my own progression as well as theirs. And when I jotted down the meeting I’d had with my supervisor to plan a similar piece of work with someone new, I was pleased to find that I’d contributed a lot more to the plan, made appropriate suggestions, and was feeling far less worried about the first session. I guess it just really helped me to see that even in my own quick notes about my work – and despite feeling like an imposter at the times of all of them – there seemed to be evidence that I had improved in confidence and knowledge.

Parental Wisdom

If all else fails, call someone wiser – thus usually older – than you, and have a small existential crisis about what the past 6 years of your life have been about, how despite academic evidence proving otherwise you are actually the least intelligent person potentially in the whole past and present NHS, and how perhaps you are actually deeply and fundamentally unsuitable for this job after all. HOWEVER.¬†I have heard warming accounts from at least 5 actual, real adults (both of my parents included), that most people are muddling along, most of the time. Apparently – and I don’t know whether I find this comforting or terrifying – you never feel like You’ve Arrived and You Know Exactly What You’re Doing. As long as you muddle on with a sense of confidence and a willingness to ask for help, that is generally acceptable and typically suggests you’re actually doing alright in practice. It sounds¬†ridiculous,¬†but knowing that people who I see as pretty competent and successful in the adult world (not¬†that adult world!) also feel like they’re imposters was so useful. It’s a little something I keep tucked in the back of my mind for when I still feel shit even after doing all the more practical things above.

 

I was going to add a 5th suggestion of asking to be observed/recorded in your sessions to review with your supervisor… but I know this is such a horrific prospect that I would struggle to say anything positive about it. I have done this. It was desperately uncomfortable, despite general good reviews and much useful, actionable criticism. But I’m still not over the trauma of it yet, and so am unable to reflect on how it’s potentially the most useful thing one could do. If I ever manage to be observed without feeling like I have suddenly turned into a potato with a clipboard and some CFT circles diagrams… I shall report back.

 

 

 

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On tiredness.

Ah god, I’ve given too much of myself this week I think. And by week, I mean the past 9 days since I don’t exist¬†on a conventional weekly calendar system anymore. Ho hum.

I usually pride myself on being pretty hardy. A Series of Unfortunate Events, several series in fact, across my life have taught me how to look after myself and I find usually I can intuitively give myself what I need, and then some. But this past run of shifts has been extra difficult, and I feel emotionally drained. This is a new feeling, as I don’t usually get that ‘compassion fatigue’ you read about. But today, when I just could not keep my mind from wandering when I had a hysterically weeping, desperate lady on the end of my phone… yep there we go, I think my compassion is well and truly tired out.

Why? In the context of a team where I find a not-insignificant proportion of the members to be punitive, unkind, and slapdash, I end up covering their gaps. I do this because I want to, and because I can, but I also am aware I find it hard to say no and I’m not very good at drawing lines.¬†I’ve gained myself the reputation of a) being good at my job (this is good), and b) being good at everyone else’s job too (this is less good), I get dumped with work that shouldn’t really be mine. We should be sharing equally. But I say yes, anyway, because I have faith in myself to do a good, or at least well-intentioned, job. Maybe tomorrow when someone says ‘d0 you mind just popping down to see so and so’ I should just say no.¬†I also feel like I am fighting people’s corner constantly, which is actually so tiring (good job, lawyers, it ain’t easy). In meetings I’m tempering multiple mean remarks about people who are in terrible pain, and trying to say ‘believe it or not, they probably aren’t self harming just to spite you’: this leaves me feeling battered. I’m not very good at confrontation in any situation, and so I find this emotionally and socially difficult to cope with. This all sounds dramatic and paints me in the light of being some kind of crisis team hero: I’m really not. When shifts are staffed with the positive, compassionate half of the team it’s a walk in the park. I’ve just had a run of shifts where this hasn’t been the case; and I’m not afraid to call out some caring ‘professionals’ for what they are: not professional nor caring.

In the context of a city full of social pain, as a crisis service who accepts¬†everybody, I feel I have to cover the gaps our cruel government leaves gaping open. The person who would probably be feeling a lot better if the DWP didn’t keep declaring him fit to work when he really isn’t? Sure, I’ll sit with you and do your claim forms, the appeal forms, all while hearing your painful life stories. The ‘illegal immigrant’ who is so, so traumatised by what happened to him¬†(as a result of us getting involved in) his¬†country? He’s never going to access long-term mental health services in the UK because he isn’t meant to be here. So I will sit here, and try to absorb some of your sadness, and try to help you know you are worthy and you are not to blame and you are not bad. The woman who’s children who have been taken from her because she couldn’t stop taking drugs because her ex partner couldn’t treat her like a human? I guess I’ll sit with you, too, and try not to cry myself when I think of my mum in your situation*. I know I can’t solve things, I know no one person can.¬†Believe me, my ‘rescue complex’ buzzers are beeping so loudly right now. It’s extra difficult because at this career stage, what I can do is limited. I’d never step outside of these competency limits because that would be unsafe, but it does feel a bit helpless: what am I actually¬†doing?

This is such a woe-is-me, self-indulgent rant but I’m feeling sad and tired. Time to go eat some nice food and go for a long radio-4 fuelled drive I think, time for me. I’ll bounce back, but I don’t think it would be human to do this work without having days like this where I feel angry, sad, and a bit useless. Such is life ūüôā

I also haven’t proof read this – I have ice cream to attend to – so excuse any typos in amongst the tenuously related brain vomit. xx

*These are all – of course – created characters. An amalgamation of different people, situations, and problems I and others have encountered.

On ‘personality disorder’

This is a post that has been brewing for months. It is also a post that will never be able to cover the ground as eloquently and intellectually as others I’ve read.¬†Swearing ahead, btw. A rant more than anything else, with little critical thought or solutions attached. Hope some of you can relate. I feel really down about this.

I will preface this by saying I¬†abhor¬†the term ‘personality disorder’. Applying the label of ‘personality disorder’ to a person is a violent act, in my opinion. I use it here, in quotation marks, only because it is common language that others will understand. I also appreciate that for some people the label doesn’t bother them and by hating the term I’m in no way belittling the experiences it might¬†encompass.

I had never heard of ‘personality disorder’ until a lecture on it in year two of my undergraduate degree. The first thing I learnt about it was that it pertains to people psychiatrists hate. Ouch. Stepping into a crisis team showed me immediately that this theme is so entrenched in modern mental healthcare, so much more horribly and commonly than I had imagined. I’ve seen it in clinicians who I’ve otherwise respected and thought highly of. If I never have to hear anyone sigh ‘ugh she’s just SO PD’ ever again, it will still be too soon.

I cannot fathom the complete void where care and empathy should be as soon as a person is deemed to have a ‘personality disorder’. We somehow manage to sideline the fact that a lot of people with the diagnosis have had horrible, traumatic lives, and have been through things I can’t imagine surviving. I have pointed this out at work, before. I’ve not got an overly warm response.

‘Personality disorder’¬†means that a person can’t be in crisis, and they can’t be helped by us. We don’t explain them properly in handover: a person with psychosis might get a five sentence summary of how they are and what their difficulties look like. A person with ‘personality disorder’ will get ‘Anne, 59, PD’, which I mean… isn’t very fucking informative, now, is it? In fact, I’ve discovered that we even present people as ‘PD’ who¬†don’t even have a fucking diagnosis of ‘personality disorder’.¬†

It hurts me and if it hurts me it must hurt the people we are systematically failing, demeaning and invalidating. I don’t know what to do about it. It’s not like I can report an individual staff member –¬†everyone¬†seems to hold the same attitude, to varying degrees. I’m not saying I’m perfect – I’ve worked with people I’ve found frustrating, dismissive and ¬†yes – irritating. But I always seek to contextualise it, think about why I’m experiencing the person in this way, and most fucking importantly to not let it impact the care I’m giving as far as humanly possible. It feels like being caring myself, within my own limits and competencies, is all I can really do. How do you change a culture like this? I just don’t know.

 

On mental health nursing

On mental health nursing

I’m going to preface this post by saying I have nothing but respect and admiration for mental health nurses. Their job is Hard Work. I don’t know about other places, but in my service, they are the motor that keep the whole thing running, and the glue that holds the team together. I’ve worked with highly knowledgable, medicalised RMNs, and RMNs trained in therapy, who are more holistic. All of them have had something beneficial to offer, and I really don’t want this post to come across as if I’m slating mental health nursing as a profession. I’m not. I really hope it doesn’t read that way.

I get told daily, perhaps even twice daily, that I might as well just apply for the postgrad mental health nursing course now. In my team, there’s a trend of people starting as psychology grad support workers, and leaving as mental health nursing students. So I guess when I rock up, fresh out of a psychology degree, they assume I’ll go down the same path. Despite me expressing otherwise. I find this¬†really difficult. Why? Because I don’t want to be a nurse. Believe me, I’ve considered it, and researched it heavily, but I’ve come to the same conclusion each time: I don’t want to be a nurse. Not because I don’t think it’s a worthy profession, but because I want to be a psychologist. I want to use the subject I love to help people. I want to continue to do research. I want to formulate, not to help diagnose. I want to lead on the development of services that really fit the people they are there for. I want to help people without medication, because that’s something I truly value and think there’s a place for, but not enough¬†access to. I don’t know how to put into words why this is what I want to do, but it is. And it frustrates me that people assume I just want to do therapy; if that was the case, I wouldn’t be putting myself through this path.

That’s not to say I’ll never be swayed from the clinical psychology path; I know it’s difficult and competitive, and that not everybody who wants to do it will be able to. But some people do get onto training, right, each year? So at this point in my journey, I see no reason why it shouldn’t be me. Maybe a few years on, where I’ve had a few failed applications, and am struggling, maybe that’s the time to give up. I just don’t feel like I need to give up now.

Is that perhaps naive? I hope it’s not – but it absolutely could be. I’m realistic; I’m not going to apply for 10 years straight and keep hoping. I do have other career paths in mind that I think I could enjoy, like speech and language therapy or special needs teaching. Once I start applying, I will give myself a mental ‘cut off’ date, mainly because I find it difficult working with complete uncertainty in my personal life. I can’t live on a support worker’s wage forever! But equally, I’m in no rush. I know people in my year at uni who applied straight from undergrad, and were desperately disappointed to get no interviews (as I would have been!) I’ve always wanted to work in mental health since I knew it was a thing you could do, and now I’m here and I¬†love it. So I’m more than happy right now to pootle along until I feel ready to apply and throw my hat into the ring. I just see no reason now to default to nursing, just because I might never be a psychologist. It feels really disheartening to be told so often that there’s no point in trying, and I’m unlikely to get there.

Equally, I feel it’s a disservice to nursing to put it as a default. There are 100s of people who want to be mental health nurses in the same way as I want to be a psychologist, and they are more deserving for places on the postgrad course than I am. I wouldn’t train as an RMN as a back up career, no way, I’d only commit myself to that if I really felt it was what I wanted. Yet being told daily that I should makes me doubt myself: I get told stories of girls who had five years of experience, a masters, shadowed 5 psychologists, worked in every service and setting, had great clinical skills, therapy training and… still didn’t get on to the DClin. I am quite a self-doubty person anyway, so this does nothing for my own sense of ambition and persistence. I know so intensely that it’s what you learn from what you do, rather than how much you do, that will help you develop. But it’s just when people tell you so frequently (and well meaning-ly, I must add!) that it’s not worth the bother, I end up second guessing myself and wondering if I am cut out for this after all.

 

This is such a self-indulgent ramble ūüė¶ I’m so used to writing essays that have a coherent and concise argument to them, so¬†this reads horribly to me. I guess the argument, bullet-pointed, is that:

I don’t want to be a nurse

(But I do really value nurses)

But being told I’ll ‘end up’ being a nurse anyway

Is kinda hard.

 

 

Woe is me, ey?

On being a little fish

On being a little fish

“Are you just here to drop off my pills?”

I always performed well at school, and got fistfuls of A*s. I battled with an incredibly academic course at a top uni and am now skipping away with a 1st class degree, with honours (p.s. what does the honours bit even mean?)

But really, that doesn’t mean anything in The World of Work. In the crisis team, it doesn’t matter that I have an IN. TENSE. understanding of the dopamine hypothesis¬†(and why it’s shite) (oops). If I struggle to engage with a service user experiencing strange thoughts and perceptions, the fact I can recite 15 studies evaluating the efficacy of CBTp is meaningless. I am a lowly support worker, surrounded by highly skilled and experienced doctors and nurses.¬†I am now a little fish in the big pond.

Now, I don’t want this post to sound like I’m tooting my own proverbial horn and having a big old whinge. I’m finding this unsettling – admittedly, but also really, really interesting. So here are some ramblings about suddenly finding myself at the bottom of the ladder:

Identity

So much of my identity – all of it? – is tied up in being good at school stuff. I was always the clever one; the one people would give essays to read, and practice papers to mark. I work really, really hard, have unrelentingly high standards, and pride myself on being The Clever One. Most things I’ve worked at that have tangiable end points have been academic, and so I don’t have much experience failing in¬†pursuits I care about and value. My job is, therefore, new territory entirely. I find it difficult that I’m finding things difficult. And this job isn’t something I can go home and revise until I just know it; it’s something that will come through experience and mistakes. This is pretty novel for me, and I feel a bit like I don’t know¬†exactly what my role is because the role I’d usually assume is so far out of the reach of my experience levels.

I guess also – if we’re being brutally honest, which we can be, because this is anonymous – I guess it feels a bit unfair to have studied really hard and got high grades for three years at uni, to now find that a lot of it isn’t very helpful in practice. I can accept this; a BSc in Psychology isn’t a vocational course, it doesn’t qualify you to Do Psychology. But I do feel like I know things, or at least have the ability to research things and present what I find back, that could be useful.¬†Psychology isn’t valued in my service, it’s not ever really talked about as something that might be considered useful, and this feeds into a veryyyyy medicallllll approachhhhhh. Which, obviously, I’m not that well versed in. Thus hitting me in the identity crisis once more. I’m¬†extremely cautious about not¬†coming across as a Poncey Psychology Graduate; I wasn’t employed to be a mini psychologist. I was employed as a support worker. This is fine; but also new ground for me. I’m learning.

Hierarchy

Psychiatrists –> mental health nurses –> support workers. This is how my, and I’m sure many other, teams feel. This is a bit uncomfy for me due to the same identity issue outlined above, but also because I¬†do¬†think everyone in the team has something to offer. I have the time to help a service user walk to the shop at the end of the road and back,¬†and to do the preamble before to scope out what their¬†worries are, and the post-amble(?!) afterwards to evaluate how it went. The nurses can do this less; they’re the ones who can answer the medication questions and who have to care plan and assess and risk assess and re-care plan and and and.. the list of responsibilities goes on. The psychiatrists in my team are under huge strain and rush around all day long from place to place doing highly skilled, complex work that I totally don’t understand.

I can tell the team – in practical terms, functional terms – about how a person is doing making¬†baby steps towards feeling better again.¬†And this can feed into molding the service around the person: a service user who took half an hour to get to the shop and back with me, is unlikely to make a 9am appointment at the busy hospital in town, regardless of how many mg of medicine you give them. But as there’s an implicit sense that what I do with service users is of less urgent importance than medication and risk work, these messages are awkward and difficult to communicate. And don’t get me wrong: medication has it’s place. And risk assessment is¬†important. But when there’s 459,000 people on the caseload, and any information superfluous to: ‘are they taking their meds’ and ‘are they thinking about suicide’ is deemed less important, I really feel like we’re losing the fact that we get paid to support¬†people. Perhaps we should have some intermittent¬†handover sessions that are¬†solely focussed on outlining how people are getting on on a human level. Hmm.

 

Does anybody else feel/used to feel like they’re a little fish in a big pond of clever, qualified health professionals?

 

 

 

Journey of a Psychology Graduate

Journey of a Psychology Graduate

Hello!

Welcome to my blog. I’ve recently graduated from a UK university with a 1st class degree in Psychology, and now I’ve got my first job in a crisis team in a big city. I love reading blogs about other people’s experiences in mental health work, but I haven’t found many from people like me — so here one is! My aim is to eventually be a clinical psychologist. I know it’s going to be a long road – and perhaps not even a successful one in the end – but after my first month at work, I know I’m going to have a lot of thoughts on the journey. This is a space for them. And if one more person tells me I might as well give up on the clinical psychology dream now… >:)

Some background on me: I come from a little village and I moved three years ago to a big city to start my psychology degree. I always assumed you could help people in two ways. First, as a clinician. Second, more indirectly, as a researcher. Clinical psychology can allow you to do both. From my degree, I gained the bread and butter knowledge of concepts, theories, evidence. From the wonderful resource that is Twitter, I learnt from professionals on the ground, service users and service user activist groups, nosing in on exchanges between psychologists and researchers and people who use mental health services, Psychologists Against Austerity… all sorts. Voluntary work made it apparent that.. hang on.. I might be quite good at this listening to people business?! I adored the research aspect of my degree, and despite many a late night desperately word cutting from lab reports, I seem to be alright at it. Together, these things solidified that yup: this is what I want to pursue. And that’s the potted summary of how I ended up here, with a shiny NHS ID card¬†.

My job is in a crisis team, and I will admit I feel thrown in at the deep end somewhat. Mainly with the driving through city centres rather than with visiting people in their homes! ūüėČ My team is mental health nurse-heavy, with no psychology input. The latter is a shame, but I don’t think it restricts my ability¬†to think psychologically, and treat people… like people. I don’t want to drop off medication and leave again. I don’t think that’s conducive to long-term ‘recovery’. This blog will chart my journey through this section of my life and career, and hopefully beyond. I have no particular plan for the blog; my first month has thrown up a lot of Issues To Think About, and Feelings About The System, and Thoughts About How We Support People. There are certainly things I disagree with or that sit uncomfortably with me. I’ll use this blog as an outlet to think around all of these things and try to reflect on and learn from them. I might also blog a bit about my experience of uni… not sure I’m quite ready to let go of being a student yet (or the wonderful discounts that come with it).

So there we have it! A brief introduction. Thoughts, rambles, and vents to follow…