Clinical Psychologist questions

[Birdsongsinging]

I am a Clinical Psychologist in the NHS and wondered if anyone wondered about anything that I could try and answer?

What does a clinical psychologist average day at work look like?
What experience/training/qualifications do you have?
Can you prescribe medication?

Oh thank you! Could you help with a qualifications question?

I work for a mental health charity and I don’t have any training or qualifications. I would like to get something under my belt so I (a) feel more like I know what to say/how to be/know what I’m talking about when I’m a session with a client and also (b) could get a more secure job - this one is hourly paid and low paid.

Yesterday for example, I found myself wanting to talk about the ‘child’ and the ‘adult’ and wanting to understand what was going on for a client in terms of these sorts of things.

What sort of course would teach me about theories of mind etc? I’ve been looking at a conversion course MSc Psychology and also been pondering some sort of entry level counselling skills course (because counselling doesn’t have a conversion route). Would either of those deal with those sorts of psychoanalytical things or would it be something else I haven’t thought of?

Not sure if this is the sort of question you were expecting so no worries if you can’t or don’t want to answer.

The training is Psychology degree, then most people get a job as an Assistant Psychologist to get some experience, or work as a Support Worker, Research assistant etc for 1-2 years, then you apply for a 3 year Doctorate course.

While you are doing the course you are an NHS employee and earn a salary. You move round different specialisms and the core are adult mental health, child, learning disabilities and older adults. Some courses are more aligned with specific therapies but you have to come out with competencies in 2 now (I think that is right - I qualified over 20 years ago). I’m now realising I could be out of date on a few things!

We can’t prescribe medication.

An average day is tricky but involves supervising trainees and assistants, managing caseloads /arranging appointments / lots of emails and recording stuff on our computer NHS systems, seeing people for clinical sessions, travel, writing up reports etc.

I am not really sure I'm afraid. I dont really know much about other training other than that now when we advertise clinical psychology posts we also advertise for counselling psychologists. That always used to be a bit easier to get training for but I dont know if it still is.

A friend of mine is doing a course that takes 2 years and you do a lot at weekends (she is a nurse already) and it seems to be more psychoanalytic and transactional psychology.

Regarding theory of mind, a lot of the Autism literature should cover this and there is also a lot of stuff online now but again, I dont really know of specific information. Sorry not to be more help.

Thank you. What does a typical day look like in your line of work?

and could you ask your friend what her course is by any chance?

I’ve just realised you answered the typical day thing further up. MN notified me that you’d answered my question so it took me a bit of clicking around to see your other reply!

Hi, I have texted her and will let you know when she gets back to me.

Who makes a referral for a patient to see you?

What is the criteria for one patient to be referred and another not?

What is the waiting time for patients to get a first appointment with you (or a colleague)?

What has been the growth in numbers of patients referred to you (you can pick the time frame), and have the numbers of psychologists kept up?

Could you suggest how you would go about finding psychological support when the NHS provision/waiting list is unbearably long?

And if your budget for private support for your adult child is finite..is it foolish to start with a private psychologist if you aren't going to be able to afford it longer term?

Thank you

Our referrals come from a range of people but for Adult Mental Health it is usually the GP who has referred.

I work in some other services (learning disability and criminal justice) and there referrals come from social work, support providers and also other members of our teams.

We have a treatment time target of 18 weeks but most people wait more than this. There are various initiatives aimed at reducing this down but most still wait between 6 months and a year.

The number of clinical psychologists being trained is increasing - there are around 70 trained per year now whereas in the 90s it was only 20. But, with all the pressures on waiting lists and targets to see people lots of people are leaving to work privately so we have loads of unfilled posts.

I am not sure about the numbers for increases in referrals but I can only imagine that they have increased. When I first started work in the late 90's waits were only around 3 months max so the fact that now they can be up to 2 years suggests a massive increase in referrals not matched by increased training. There are now more nurse CBT therapists but not that many given how many nurses there are, although again they are all having trouble recruiting as well.

I know some people who work in England and their services are privatised so that they are now employed by companies that have contracts with the NHS. If this were to happen I can see even more people leaving to work privately and so the vicious circle continues.

It depends a bit on how long you think they are likely to need therapy for (I know that can be hard to judge). Severity of symptoms may be one indicator, or type of difficulty that they have. I dont think it is foolish to start some input though - the sooner you get help is usually the better. There is (or was) a thing in the past though that while people were on waiting lists 1/3 got better, 1/3 stayed the same and 1/3 got worse. Not sure how true that actually was although I think there was some evidence for it.

I would make sure they are on the waiting list if you do go private. Some people do offer reduced rates for low income families and there are also some free voluntary services for people with very low incomes / unemployed depending on your area.

If you told the therapist at the start you can only do x sessions then they may be able to tailor their input to maximise that.

Some NHS services also offer online input cCBT which can be all that is needed in some cases.

I am not really sure that I am telling you that much that you dont know already though. It is a real shame that it is becoming such a 2 tier service.

Do you work within a CMHT or independently? I’m an RMN and we have clinical psychologists on our team who are lovely 😊

Just realised I didnt respond to the criteria question - there isnt really strict criteria for referral other than the person is suffering from psychological distress that the GP cant manage themselves.

You mentioned it briefly upthread, but I was going to ask you: what's your honest opinion (and, if you know, your clin psych colleagues' honest opinion) on counselling psychologists, the fact they pay for their own training so it's less competitive to get into, and the difference in training/research focus, within the context of how many roles are now being opened up to clinical and counselling psychologists alike on (presumably) the same pay?

I currently work in a Community Learning Disability Team - it is a great team made up of psychiatry, nursing, OT, Physio & dietitian. I love it.

Well, my honest opinion is that their selection and training are less rigorous and I think a lot of people dont really get why they are getting offered jobs in the same way. It makes no sense. Somehow they have managed to get into a good position! Great for them but I am not sure about it all.

Because it hasnt really happened in our service though I havent talked much about it to colleagues but have read a few things. Having said that, I dont know any in post so I think when it comes to selection they probably arent selected because they arent able to do as much as a qualified clinical psychologist can.

Do you diagnose people with specific MH disorders?

"The number of clinical psychologists being trained is increasing - there are around 70 trained per year now whereas in the 90s it was only 20. But, with all the pressures on waiting lists and targets to see people lots of people are leaving to work privately so we have loads of unfilled posts"

I don't think this is correct. There was an announcement of 25 percent more trainees a couple of years back, being an extra 140 places, suggesting was previously 550ish and is now 700ish.

I work in educational psychology, there are fewer of us and we have 250 ish trained a year.

Another CP here 👋
Loads more than 70 training places per year now, I can think of one course alone that had over 40 places when I trained approx 10 years ago, and I know from a trainee CP I’m working with that their course has expanded from 15 places to over 30. So must be 300 per year at a minimum? However I’m also aware many newly qualified are going straight into the private sector and not into the NHS because of current working conditions.

Typo, 500 at a minimum I would have thought.

Thanks! I've wondered for a while about this, because from the outside my feeling was that it would make sense to feel the way you do about it, but no clin psych speaking in their own name seems to want to express any reservations at all. Perhaps you're right that the recruitment stage levels it out in practice.

I've got nothing against counselling psychs, BTW; some of the most effective and helpful therapy I've received has been with one of them. Nothing against clin psychs either, have also had great help from that side!

Hi! I am in Scotland and so we only have 2 clinical courses. I have heard that about people going straight to private sector. I wonder if they will do something to try and prevent that happening.

Sorry I should have said about being in Scotland. When I did the training there was 9 in my year whereas now there are around 35. Only 2 courses in Scotland so about 70 a year are trained here.

Do you do adult female autism assessments? A close family member was on the waiting list for assessment for several years and then when she arrived at the appointment was told by the CP that she could have the assessment but wouldn't be given a formal diagnosis because the diagnostic manual doesn't cover females, only young boys. She was confused and went through with the assessment anyway. A few weeks later the CP sent her a report stating that she believed my family member is autistic. However, this is not an official diagnosis, as mentioned at the assessment. It doesn't seem right to me. I don't want to say where this was but willing to DM you the county if it makes a difference.

No questions, but I'd just like to thank you 💙 Years ago, I benefited from a load of expensive private therapy paid for by my employer's insurance. It was good mostly, especially the residential clinic. I learned a lot. But I didn't really get 'better'. The big change came some time later when, still confused & distressed, I was referred to CMHS.

The clinical psychologist I saw courtesy of the NHS is, I maintain, a genius! The way she got me to crystallise specific issues during what seemed like a simple chat, she made all the others look like amateurs. Icing on the cake: she's a real feminist. I never once had to explain why something might be affected by my sex, she was there before me.

One of my most-loved friends is an NHS psychologist. I know the impossible pressures you are all under, at the same time as mounting pressures in society lead to worse mental health problems. I tend to feel everyone could do with some decent therapy and it's ridiculous that we are actually moving further away from that. Thanks for hanging in there!