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?

Aww that is a lovely post - thank you! Yes, it is such a shame that the whole of the NHS, not just psychology services, is going downhill with lack of funding and poor conditions. Hope something happens that turns it around!

In the learning disability service we do autism assessments for men and women. They are a multi-disciplinary assessment with input from psychiatry, Speech and language therapy and psychology, usually.

In adult services I think there is a specific service for ASD but I am not sure about diagnosis for either men or women.

Childrens services diagnose both. Again, it is a MDT assessment not just one profession.

What are your feelings regarding specialist Inpatent treatment vs outpatient for serious mental health issues

We used to more than we do now but yes, we would for example say that someone has complex trauma or generalised anxiety but in our service we are tending to move more away from medical diagnoses that arent always particularly helpful. I would tend to be more descriptive.

Having said that, I know that diagnosis is helpful in many cases both in terms of understanding what is wrong but also for benefits, work, insurance etc. We do diagnose learning disability, autism, and I suspect other things that I cant think of right now!

It seems like it is really hard for people to get inpatient treatment these days and so those that do tend to have very high need and complex difficulties. I think where there is a real risk of harm inpatient services minimise the risk but for treatment I am not sure that it is any better and often it can be poorer.

Do you think there was a period of time where personality disorders were being diagnosed and now they are not, or much less so?

Through work I see a number of women diagnosed with a PDO and their children diagnosed with ASD. Do you think some women have been misdiagnosed?

How successful is trauma counselling? I’m thinking childhood trauma and whether success lessens as age increases?

Thanks

Thank you

I think personality disorders are still diagnosed by psychiatrists but in psychology we are understanding them in the context of trauma and the effects of trauma on their relationships and functioning.

I am not sure about the link between women diagnosed with personality disorders and children with autism. It sounds like a really interesting link.

Regarding trauma therapy, I do think there is a lot that works with people who have experienced trauma. I have recently done EMDR training so am just starting to use that but I think a combination of approaches can be really helpful.

I dont think that it means you are less likely to do well if you dont get any input for trauma until a late stage. It may mean that you have learned some coping strategies over the years. I am no expert though as I have never worked with children who have experienced trauma though.

Hi, @Chat135456

The course my friend is doing is this one: https://www.physisscotland.co.uk/
She totally loves it.

@Birdsongsinging how long have you been qualified and what area do you specialise in?

I dont really want to say as it will be a bit outing! There's not that many of us about in Scotland!

I am not sure about the link between women diagnosed with personality disorders and children with autism. It sounds like a really interesting link.

Even just as a patient who sometimes needs MH services, I've met at least three adult women diagnosed with BPD who have a first-degree male relative diagnosed with autism, and at least another three women diagnosed with PD who were then assessed by NHS ASD services and diagnosed with autism.

When boys and men struggle with communication, social interaction, emotional regulation and self-injury, first thought is autism. When women and girls struggle with communication, social interaction, emotional regulation and self-injury, first thought is that they have a flawed, hysterical, character (too angry, too dramatic, too needy), or that they need a label that warns other professionals that they're "difficult", and, well, BPD/EUPD is right there. (And their social difficulties often result in others taking advantage of them, meaning many have a trauma history, which bolsters the PD hypothesis.)

Do you work in the community or in inpatient care? Someone close to me is a long stay in patient in a psychiatric hospital. I must admit, the process of working with the psychologist baffles me and seems very slow. They are using a formulation approach, which is supposed to lead to a treatment plan, but after six months of them working together they still don't seem to have embarked on any therapy or treatment.

I agree that there is a huge difference with the way people (mainly men) view women versus men and the understanding of how they present is skewed by this.

I work in the community. We would also work based on formulation but it would be much quicker than what you are describing. That doesn't sound great that they are 6 months in and not started any therapy.

This is great! I'm really cynical about counselling given the lack of regulation and training requirements particularly vs psychology etc. what is the difference and what's your view on counselling

Do you see many people with DID? How is it viewed amongst your colleagues and how is it treated?

I have to admit I had to google DID as i had never heard of it! However, we do see lots of people who dissociate. Again, with better knowledge of trauma I think there is better understanding of dissociation. When you ask about how it is viewed I am not sure what you mean. We all accept it as something that people experience and find distressing.

It is treated through understanding of why it is happening and tackling that, but also there are 'grounding' techniques which are used to try and help the person be 'present'.

Does that answer the question? Please say if I have got it wrong.

There is a whole issue about who can call themselves what and what titles are protected. I think there are lots of people who call themselves counsellors who have done courses that are not really that great and it is difficult for people seeking help to know what to look for.

I think like anything else there are good counsellors and poor ones but on the whole I dont really know enough about their training and what they do!

Thank you!
very informative thread thanks!

Hi @Birdsongsinging , I have a question about ratios of men and women working in psychology. DS is thinking of applying to study psychology as an undergraduate next year with a view to eventually becoming a psychologist. He’s noticed that, for unis that give this information, typically around 85% of the students are female. Is this reflected in the number of men in the profession and is this in any way likely to be an issue (eg do people prefer to be treated by a woman?)

Hi @HealthyFats

Yes, there are many more women Clinical Psychologists than men but, sadly, like lots of situations, men are disproportionally represented in higher positions, same as in nursing. At the moment we have more male assistant psychologists than female but of the trainees only about 10% are male.

For getting on courses it should make no difference though, selection is anonymous until interview stage.

Regarding people's preferences, it helps to have both men and women able to provide input as some prefer seeing a man and some a woman although in our service it is really difficult for them to have a choice as there are not many male psychologists. In the forensic psychology services there is probably a more even split of male to female psychologists.

So basically, although there are more women than men there is no reason for your son not to apply and it certainly wont be a disadvantage and may be a slight advantage.

When you are working with a client, how much outside info do you gather? Do you talk to relatives and friends at all to build up and accurate picture?

I only ask because my abusive ex has his psychiatrist convinced he suffers from fear and anxiety.

When you get to consultant level, how much management do you have to do?

Can I ask how much experience you had and how many years it took you to get onto your DClinPsy?
A family member is currently an Assistant Psychologist but plans to apply for courses in the near future.