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AMA

See all MNHQ comments on this thread

I'm a consultant clinical psychologist AMA

69 replies

midgeattractor · 30/06/2018 22:04

Ok then!

I've been working in the NHS for 21 years, in a variety of specialties and regions. Does anyone have any questions Grin

OP posts:
IStillMissBlockbuster · 01/07/2018 21:30

How do you get to consultant status?

NeverLovedElvis · 01/07/2018 21:36

What are your thoughts on the tendency for people to hand out 'armchair diagnoses', both here and IRL?

Do you think it matters when people use words like 'trauma', 'depressed', 'meltdown' and 'ocd' in ways that do not match their clinical meanings.

Slowtrain2dawn · 01/07/2018 21:49

No question, just thank you for mentioning the Power Threat Framework. What an amazing resource.

midgeattractor · 01/07/2018 22:25

Psychologists tend not to diagnose, we are trained to work with you to make what is called a formulation. There is more information about this here: www1.bps.org.uk/system/files/Public%20files/understanding_formulation.pdf

A consultant is a senior clinical psych, often with management responsibilities. In the nhs there is not really any scope to just be promoted; a consultant job is either created or vacated, and you can apply. The interview includes the recruiting organisation staff and one or two 'external assessor' interviewers, who are experienced consultants and who have been given further training by the dcp, in order to ensure that interviewees are suitable.

OP posts:
midgeattractor · 01/07/2018 22:33

Willworkforfood- sorry to hear how tough things are for you.

In the past a pd diagnosis could cause a barrier to treatment. There has been significant movement over time, and we are better at understanding a range of factors which result in 'pd', and we are also hopefully using things like formulation and the power threat meaning framework to try and actually make sense of the individual and make a treatment plan. We also know more about the effects of early trauma / neglect / chaos on brain development, and the consequences for how an individual manages emotions, relationships and life. I think things are much more optimistic for folks with this kind of history, but as you say it can be a longer treatment, and it depends on what is being developed in your area. Expert therapy for complex cases is an expensive resource, and despite the government trying to train cheaper therapists, it is clear (imo) that non expert, uni modal therapists are not making the gains that were hoped.

I hope you find something that works for you. There are some new 'third wave' therapies being developed which offer a good chance of recovery.

OP posts:
spagfullofball · 01/07/2018 22:40

Ive been through a block of psychology and had help from occupational therapy for severe depression and anxiety over a year ago. Although I wasn't able to go out myself, I was discharged. I've barely been out much or at all myself since but feel I've had all the help I deserve. If you've seen a patient before would you think they're a failure if they were to end up referred back?

midgeattractor · 01/07/2018 23:01

Elvis- I don't mind about people using terms in any way they like - everyone is trying to understand themselves or others. I do think there is a massive risk to us accepting diagnoses as 'facts', and this is probably the problem with the armchair stuff. It reduces us to think in labels, most of which are not actually very scientific; dsm and icd are basically devised on a 'who shouts loudest' and 'who is mates with who' basis.

Spag - very few professionals would ever think that. I've seen a good chunk of people a few times. Sometimes you do what you can for now, and come back again for a bit more. What you 'deserve' is to be feeing better, taking your time is ok.

OP posts:
RallyRoundTheFlagBoys · 01/07/2018 23:08

What would you think was responsible for long term extremely rapid mood swings (elation and complete despair all within the space of half an hour, for example)?

Dragonlight · 03/07/2018 01:35

How do you deal with not liking someone?
Do you ever think 'if we met elsewhere we could have been friends'?
Do you ever feel compassion fatigue?
How do you deal with someone crying?
How do you work with trauma?

CBTTherapist · 03/07/2018 07:41

Dragon,

I’m not OP nor am I a clinical psychologist, but I’m a CBT therapist working within adult mental health, I treat common MH issues such as depression and anxiety disorders, so I can answer your questions if you’re interested (no doubt my response will differ from OP’s experience though)

“How do you deal with not liking someone?”

It’s actually incredibly rare I don’t like a patient. It’s a strange phenomena, but in my experience of being a therapist I’ve almost always found that even when I don’t really like someone to begin with, I always grow to like them! Maybe it’s because over time I can start understanding why they’re the way they are, which humanises them, plus I have more time with them to see their more enjoyable qualities rather than the things that give an instant ‘dislike’ response. In 99.9% of cases by the time I finish therapy I genuinely like and feel very warm towards somebody (I can’t even think of anyone that hasn’t happened with but I’m sure it might have occurred so I’m sticking just below 100%).

If I don’t like someone I just remind myself I don’t necessarily need to, I need to understand them well enough to help them, and convey that I’m listening, I care, and I respect them. I often will try and figure out exactly what it is I don’t like about them so I can challenge or understand it: maybe they remind me of someone who I used to really dislike at work, which isn’t their fault. Maybe they have bigoted or racist views, so I remind myself they’re a product of their environment and likely believe they’re in the right and that we don’t have to have similar ideals. Maybe they’re difficult personality-wise, which I can take into account while trying to understand what their life is like outside of the room and how others respond to them.

“Do you ever think 'if we met elsewhere we could have been friends'?”

Quite often, it goes hand in hand with the growing to like pretty much everyone. I’ve definitely worked with clients I’ve been sad to see leave and thought that in a different setting we’d become friends, it’s sad recognising that that won’t and can’t ever happen so I just remain thankful for the time we spent working together and what I’ve learned from them.

“Do you ever feel compassion fatigue?”

Yes, usually just mild at the end of a difficult day or week where I can’t be bothered to talk to anyone or I’m struggling with the last person of the day to fully be present. I experienced it really badly last winter as I was going through depression and some difficult personal events, and I ended up going off sick for a month as I recognised I didn’t have the capacity to care about anyone or anything at that time, which made me an ineffective and potentially dangerous clinician.

“How do you deal with someone crying?”

Stay focused on what they’re talking or crying about rather than the tears. Tissues are accessible and visible but I don’t rush to hand one over as that can feel a bit ‘stop crying’, and makes it seem like I’m uncomfortable with it. Crying is such a normal healthy human experience. And if I interrupt it the client might leave the emotional state they’re in where I can maybe access thoughts and feelings they keep hidden at other times.

“How do you work with trauma?”

I treat PTSD using CBT (you can google for info on what’s involved). I don’t work with ‘trauma’ so to speak unless it’s developed into a diagnosable disorder such as PTSD.

Happy to answer any more! Sorry to piggy back OP. I guess I could start a threat but I’m a little wary of not knowing all of the answers haha.

Dragonlight · 03/07/2018 21:50

Thank you CBTT, I do have more questions but just kid wrangling so will be back later. This is a subject I am very interested in.

Biologifemini · 03/07/2018 21:55

How do you help prevent mental health issues occurring in children?
I mean for an average child in the absence of abuse or serious trauma etc...ie any top tips for parenting

JohnnyMcGrathSaysFuckOff · 03/07/2018 22:01

How common do you think suicidal ideations are in the general populace? Do you consider them to be a sign of mental ill health? Or perhaps just immaturity?

thesnapandfartisinfallible · 03/07/2018 22:10

Do you ever think badly of a client for crying or find them a bit pathetic?

Do you actually care or just pretend to?

Do you think PTSD can be brought on by a relatively minor situation if it was on top of existing mental health problems?

How would you react to someone saying they want to kill themselves?

Dragonlight · 04/07/2018 08:10

How do you know what to say and how to say it? I'm always amazed by that although I know it can't be easy always!

How do you protect yourself from being affected by clients with abuse, trauma etc, especially if you have similar backgrounds?

How do you ensure safety if you work for yourself?

Have you ever been stalked or threatened?

How do you know v when a client has finished treatment? (Talking more about private clients, not the public system that only gives a certain number of sessions)

Do you ever get frustrated with someone?

What do you think does the most damage to mental health?

lola212121 · 19/07/2018 15:35

@midgeattractor I am hoping to work as a clinical psychologist eventually , can you work part-time ? Are you on your own a lot or as part of a team as a clinical psychologist ?

M3lon · 19/07/2018 15:42

Do you ever lie to people? I mean telling them things that aren't true in order to help them get better?

causeimunderyourspell · 19/07/2018 15:48

Have you ever found a particular case disturbing or troubling?

AnyaMumsnet · 20/07/2018 12:10

Hi there everyone,

We'll be moving this thread to AMA so it doesn't disappear.

gesu · 20/07/2018 20:21

May be a silly question but I've never really understood the difference between a psychologist and a psychiatrist? What's the difference?

csa26 · 20/07/2018 20:34

Why is the quality of mental healthcare in this country so AWFUL? Why are people prescribed drugs and offered no other help when the NICE recommendation for their condition is CBT? How can a mental health patient be pressured into taking Lorazepam (told she can’t leave the hospital until she has it) then when she’s dependent on 2 of them a day, be cut off it completely by her GP because ‘you can just go cold turkey’ (she tried to go cold turkey; after a few days the danger to her life was so obvious to the friends caring for her that she went back on it).

I could go on all night (have nearly two decades of material) but I’d end up too angry to function probably. I realise funding is a lot of the problem but it really doesn’t account for the atrocious attitude I’ve repeatedly witnessed from healthcare professionals towards mental health patients...

LipstickHandbagCoffee · 20/07/2018 21:51

gesu,a psychologist usually has a psychology degree (or a conversion diploma) and psychology post grad
A psychiatrist is a medical doctor with additional post grad qualifications in psychiatry

Completely different career paths

SimplySteve · 20/07/2018 21:53

What do you think of the specifications of M.E as a psychological condition?

mumsiedarlingrevolta · 20/07/2018 21:55

DD-early 20's-has very very very poor impulse control.
diagnosed years ago but manifests itself constantly in poor choices.
She is very frustrated and very down on herself.
how do we help?

User183737 · 20/07/2018 22:00

Rally sounds like borderline pd

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