Mental Health Nurse working towards Counselling Psychology

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Mental Health Nurse working towards Counselling Psychology

Postby Leems » Fri Nov 17, 2017 7:13 am

Hello all! Leems here, thanks for all the superb posts I've been devouring over the last few days, really helpful.

Someone said it was a shame that more people don't start posting early in their Psychology careers here (e.g. cappucinomonkey's relevant thread), and continue to do so as they progress through it and into senior positions. So, I would like to perhaps give a little something back for the useful advice and encouragement I've received through lurking here by providing some transparent and honest commentary.

I am a mental health nurse in my early thirties who has tentatively decided to train in Counselling Psychology. Being a pondering, curious sort of bod, career advice since my early teens always pointed in this direction. My life has not been without incident, though, and my interests have been broad underneath the general heading of 'how people live', so I'm only now coming around to it with a tight focus. I like to think having developed skills in areas like teaching, clinical practice, management and research, I am in good stead.

I have a BA (Hons) Philosophy and English (2.1), PGDip Mental Health Nursing (Merit), and an introduction to counselling skills course. I'm starting my Level 3 Certificate in Counselling Skills early next year. I have roughly seven years of full time experience in nursing, starting as a band 2 auxiliary and now a band 5 nurse. My pre-registration experience was mainly in stroke, neurology and neurosurgery, but I qualified as an RMN in order to be more holistic a practitioner. To improve mental health care provision and sharpen my holism, I've worked post reg in the traditionally 'general nursing' areas of palliative care and HIV. So while I'm a shop floor nurse, I also spend as much time as I can delivering teaching to students and general nurses on mental health, performing psychosocial and non-pharmacological interventions, doing substance misuse work, performing behavioural/risk management, practicing spiritual care and focusing on clients with severe and enduring mental health difficulties. I've also completed roughly 120 days of vipassana retreat so the mindfulness gig is close to my heart, and my first publication (a qualitative study on patient experience of surgical options) will be published next year.

My current work feels innovative, helpful and creative, but I am acutely aware that I am not a qualified therapist and am not on any recognised pathway to becoming one. I see three options open to me:

Option the first: go back into traditional mental health settings and angle to become a CBT therapist. I want to be more integrative, though, so this feels limited compared to:

Option the second: go into chaplaincy (given my interest in spiritual care) or psychotherapy (given my interest in client contact). I don't feel called to ordain though, and psychotherapy feels limited as a career compared to:

Option the third: become a counselling psychologist.

The pros and cons, risks and benefits of psychology training have been, I feel, well documented on this forum, so I will not reiterate them. Having worked clinically for years my eyes are open. My gut tells me that if I want a humble and sane route, I'll become a psychotherapist- I've already got student loans to finish paying off for a start and the client contact is the important thing. But I love a challenge and I might always regret not going full tilt and becoming a counselling psychologist. I feel I have a lot to offer the profession with my broad skill base, and that it is a new profession still capable of growth and clarification, with the capacity to challenge healthcare to be more person-centred whilst remaining rigorous and scientific.

The provisional plan is:
1. Do the Experimental Psychology MSc at Sussex to gain the graduate basis (a short sharp year of hell but interesting)
2. Try and gain an role in mental health, palliative care or spiritual care related areas (AP? IAPT?)
3. Do the DPsych at City Uni London (well regarded and seems integrative)
4. Try and find a position mixing teaching, research and clinical duties

or plan B:
1. Do the PGDip in humanistic psychotherapeutic counselling at Brighton
2. Train in cognitive therapies to become more integrative
3. Do a research PhD and become a clinical academic if I want to

I feel I have until I complete my counselling skills course to decide on this firmly, so I'm not fretting particularly, having plenty of time to keep researching.

I will keep posting whether this line of enquiry ends abruptly or I turn into a tweed-jacketed Psych Professor. All comments, suggestions, criticisms, corrections and encouragements welcome. Thanks!

(edited for clarity)
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Re: Mental Health Nurse working towards Counselling Psycholo

Postby mungle » Fri Nov 17, 2017 1:42 pm

Welcome to the forum! All of those options are possible but it depends what you want your working day to look like over the next few years and 5 years from now and also how much time you want to put into the working part of your life at the moment. What is your ideal?

Your MH Nurse status gives you a core profession, allowing you to train as a psychotherapist. You mention CBT or counselling/psychotherapy. Other options include Cognitive Analytic Therapy, Brief Psychodynamic, full psychoanalytic training, group analyst, interpersonal therapist, family/systemic therapy, music therapist, art therapist, drama therapist etc. These also allow you go down the route of clinical academic. If you want to spend most of your time in direct therapy work then one of these would be the route (search for Baa's posts).

Another option for a clinical academic is to seek a NIHR fellowship to support you to do a PhD. You could also go straight into a PhD.

You can of course also get GBC status with a psychology conversion and then pursue Counselling Psychology. Would you also be interested in other psychologist practitioner roles e.g. clinical psychologist or health psychologist.
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Re: Mental Health Nurse working towards Counselling Psycholo

Postby Leems » Sat Nov 18, 2017 1:54 pm

Hi Mungle, thanks for encouraging me to explicate my ideas further.

I am happy to put considerable effort and time into my work because I love it. I put extra time into writing teaching sessions, preparing therapeutic groups, CPD, research and so on anyway because it is enjoyable; the natural move is to move into an area where I can focus on these more fully and have them contribute towards a training. I do want to be able to engage people regarding the meaning of their endeavours in the context of their whole lives though, which is why I want to have a humanistic portion to my learning. I think my ideal is that at the moment I focus as much as possible on clinical practice with minor involvement in teaching, research and management, and that the latter then become more prominent- which seems to be a logical progression anyway.

The value of having psychologists rather than just therapists was pointed out by BlueCat in this thread: "more than just expensive therapy - supervision, leadership, consultation, complex case work, complex assessment work, work where more that 1:1 therapeutic intervention is required, teaching and training, working with the wider systems, serious seats at serious tables for service development, preventative work, community focus..."

This really captures the reasons why I want to do counselling psychology. I have worked in the charity sector ever since qualifying as an RMN and I have seen the individualised, creative and holistic work that is possible in mental health. I would like to promote this in a broader way that is accessible not just by the rich in private practice, especially considering those that need such in depth support are often the ones who can't afford it. 'The path less travelled' is a theme in my career and I could see myself creating a service or organisation myself later on that reflects my own ethos as best it could. Dame Cicely Saunders is one of my heroes as a multipotentialite with a spiritual, radical and therapeutic focus towards care and I try to emulate that kind of approach.

On the other hand, it's possible I won't want to be slogging away at this level of effort several decades in, as I do have many other interests other than just work, and appreciate free time as much as anyone else. Psychotherapy is as I said the 'sane' option with additional academic and managerial work more an option than compulsory. But I tend to enjoy going both feet in.

I could indeed become a clinical psychologist, but counselling psychology seems to fit my ethos better and to allow more freedom in terms of placements. Health psychology feels a little dry, even though it would fit well with the work that I have already done in areas such as adherence, motivation, health promotion, engagement and so on.

I'm aware that I am quite an idealist, but it's got me this far in my frontline practice and I am happy to hear different views. I have open days to go to, psychologists to pester and old contacts to bounce ideas off of, so that might change my take on things.
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Re: Mental Health Nurse working towards Counselling Psycholo

Postby hs577 » Mon Dec 04, 2017 9:43 am

Hi Leems,

I think from what you've posted Counselling Psychology seems the best fit for you (or at the very least it seems like you’ve decided on this), from what you’ve described. You can do all the other things as mentioned in the Turpin (2009) paper i.e. supervision, leadership, research, audit, evaluation, teaching, formulation, therapy provision and assessment etc.

You can also adapt your placements so spend all three years for example on one placement with others alongside it as typically you need at least 2 placements. I know from my course in the North of England we could do placements at hospices, domestic violence services, prison and probation services, the school sector and the usual NHS placements like pain management, stroke, palliative care etc.

I know when I was placed in a secure secondary mental health population I used all the audit and research opportunities I could by auditing a pre-existing 5 session group, publishing papers from a previous role and I also delivered training to prison officers, probation and general resettlement staff. So there is lots of scope. As an RMN with your training in counselling you’ll have really good risk management skills as well as understanding the importance of the therapeutic relationship and rapport over approach used. You’ll also be an asset in MDT as you’ll have a deeper understanding of the medical model staff such as Psychiatry views on management of individuals as well as when this is not the most suited/needs adapting. Having said this most psychiatrists I’ve had experience of do understand and appreciate psychological formulation (individual and team) though and make appropriate referrals to Psychology.

All the best and let us know how you get on 
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Re: Mental Health Nurse working towards Counselling Psycholo

Postby Leems » Tue Dec 05, 2017 5:34 pm

Thanks hs577, your input here and on Marlowe's thread is enthusing and bringing up important topics.

hs577 wrote:Counselling Psychology seems the best fit for you (or at the very least it seems like you’ve decided on this)

I'm pretty sure those are two different things, so don't be afraid to give your own opinion ;) But cheeky comments aside, I do feel more and more that counselling psychology is the best fit for me. Qualified psychologists here have been good enough to reach out to me and confirm that I have the right idea about training and practice, and also about the limitations of a psychotherapy training (mainly that there is less room for advancement into meatier academic, management and research roles). The 'separation the thickness of a cigarette paper' between counselling and clinical psychology that others have bemoaned seems to be a bonus for me, in that I can plough into the clinical side if it becomes clear that's where the fun is on qualifying, but I can also benefit from the more humanistic teaching of the counselling psychology doctorate, and keep being a gentle rebel. Cake and eat it!

hs577 wrote:You can also adapt your placements so spend all three years for example on one placement with others alongside it as typically you need at least 2 placements

Having come from the wards, where nursing student placements can be as short as four weeks and junior doctors do four month rotations, this is a really different paradigm. As a student nurse I was really expected to do a fly by of as many topics as possible in order to learn flexibility and generalisable competencies. I'd be concerned about over-specialising if I did a three year placement, in terms of hurting my transferable skills, general knowledge and employability. However, I don't think skipping about every few months would help me to learn modalities deeply, or to have enough time to do research and make connections. I suspect I might want to do (as an ideal) a year working with people with more acute difficulties e.g. PD or PTSD to get a solid grounding in (M)CBT, a year working with people with life difficulties in a Psychodynamic way, and then a year in a hospice focusing on life limiting illness, loss and grief, psychospiritual issues, pain management etc to be integrative and specialised. I wonder what people think about this? Am I broadening my scope too much for a doctoral level training?

hs577 wrote:As an RMN... you’ll have risk management skills as well as understanding the importance... rapport over approach used. You’ll also... have a deeper understanding of the medical model

Precisely what I think I can bring to the table that conventional applicants won't, though this is why I want to do a more crunchy MSc in order to have that side of things covered. I have also read elsewhere about people's concerns that they will be reproducing learning in their doctorate, but I am a big fan of the spiral dynamic when it comes to learning and am happy that I will simply deepen skills and understanding I have more or less of a grounding in already. 'The training is what you make of it' seems to be a theme I'm reading a lot, that chimes with my clinical experience in general (be assertive, find out what you need to know, expect to self-support to a terrifying degree, have the guts to be creative). If I seem like I am planning ahead meticulously, then it is only because I know that I can attach myself to appropriate projects and people ahead of time, for example during my MSc and in my current clinical practice, rather than waste time feeling things out once the doctorate has actually started.

Next up are the open days for the various courses that have been recommended to me (Metanoia, Roehampton, Surrey, City) and poking old psychology colleagues.
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Re: Mental Health Nurse working towards Counselling Psycholo

Postby hs577 » Tue Dec 05, 2017 9:02 pm

As you've said it depends what you want to do when you qualify. I had four areas (the longest I did was over 2 years), a hospice, domestic violence service, prison (initially the primary and later secondary side) and IAPT service. I think if you want to make yourself as broad as possible then you'd basically want to do a minimum of an adult mental health service and a children and young people service. I personally wanted to have what was breadth as well as depth as being on teaching placements in the past I felt you were shunted around just as you were getting used to the staff and class.

For me personally I'd therefore, worked as a primary teacher, had worked with families etc and completed some research with children and young people (the latter as a research assistant in a psychology setting). Although I can work with children (and did successfully under those roles as I appreciate working as a Psychologist would be entirely different) it just didn't appeal to me personally working as a psychologist with children. I acknowledge that I'd have a lot of the transferable skills and get used to it. It's just not an area where my enthusiasm lies anymore and I'd be counting down until I finished for the day. Naturally I would have to develop this if I wished to in the future work in a setting with children and young people as I was mildly annoyed with myself when lots of CAMHS positions came up that were a 5 min drive away as well as one coming up where I used to live as the house next door to mine was for sale so I briefly wanted to move back! However, this annoyance overall was short lived.

I didn't personally have a difficulty obtaining a qualified job and got the second qualified job I applied for in a CMHT. The other one was also a CMHT and I didn't get a good feel for the place and wasn't impressed at the people skills displayed at interview anyway. Although I was initially upset I just wrote down the questions I was asked and acted on the bits of feedback I thought were objective and relevant and just thought if I see those recruiter's names come up then I won't apply. I also got offered another job in primary care and turned down a third interview. (I'd applied for the jobs at about the same time) and thought there was no point in putting myself in the running with what I've been offered. Either way, you'll be fine and a key difference is the mandatory 450 hours plus of placement hours as clinical do have a set number of hours but it's not as high (I believe) and the mandatory therapy in counselling psychology to support with reflection and reflexive practice. They also encourage integrative approaches towards the end such as theoretical and assimilative integration. I know our course discouraged eclectic and weren't overly impressed with pluralistic models. They also focused on specific relationship models in a lot of depth.

Both will typically follow the scientist and reflective practitioner models. Counselling Psychology had to incorporate the scientist practitioner model really to be accredited with the BPS. Thus to fit with their ethos they are ideally supposed to use a qualitative research methods such as IPA or Grounded Theory or Discourse Analysis. However clinical psychologists do this too as traditionally clinical psychologists were more popular in the quantitative domain.

I did the counselling psychology course to develop my qualitative skills as our undergrad only covered discourse analysis and Grounded theory. However, I prefer quantitative as it's just easier for my mind to interpret and my clinical psychology colleagues are the reverse in my current service so it works well for all concerned. Nonetheless it's been useful to understand and at least I had experience of using qualitative having done a mixed methods study.
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Re: Mental Health Nurse working towards Counselling Psycholo

Postby Leems » Mon Dec 11, 2017 9:32 pm

Thanks hs577. I do prefer the thought of a course with a lot of clinical hours, personal development and the relational focus, so that does put further weight on the side of Counselling Psychology- since of course Clinical Psychology did flit through my mind when I started investigating all this.

I notice that Sussex and City University London, who I am considering applying to for the MSc conversion and DPsych, both imply heavily that a purely qualitative approach is considered either inadequate or completely useless for psychology. This is a little sad to me as I think that the measurement of everything quantitatively nowadays is the real inadequate methodology to describe the world! hs577, you said that you feel Counselling Psychology pretty much requires a qualitative mode of research, so it will be interesting to see how these two approaches collide. Another reason to do the course really, and make my own mind up how to integrate them, rather than doggedly defend one or the other.

I've also applied to the unexpected opportunity of a high intensity IAPT trainee post locally, which ticks all the boxes in terms of being a stepping stone towards the DPsych that is worth doing in itself. I have historically been peery of IAPT for all the classic reasons, but I do personally need answers about how therapy can be provided accessibly without losing its soul. How better than taking up an IAPT post, rather than throw stones at it from the outside?

Lots of interesting things to find out about by trying them!
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Re: Mental Health Nurse working towards Counselling Psycholo

Postby hs577 » Tue Dec 12, 2017 10:16 am

Hi,

Good luck leems. As you said it's not useless as qualitative is aiming for depth and richness not what can be generalised. Both are ultimately required IMHO especially when you think practice based evidence and evidence based practice. To get the best of both worlds you can also use what they call a mixed methods approach i.e. sequential exploratory design (where you start with qualitative to deepen understanding then examine the themes using a quantitative approach). An example of research that did this was the CORE outcome measure (Core systems group, 1998). Thus it started qualitative using clinicians verbal explanations of what needed to be measured then did a quantitative analysis (Barkham et al., 1999). Therefore, practice research networks which fit with practice based evidence and it may be good to join one if you have a local one.

There is also the design where you start quantitative and then expand using qualitative techniques (mixed methods sequential explanatory design). The journal of mixed methods can explain further. There are also some good books on qualitative designs.

As you say it will be useful to understand IAPT from the inside, enhance clinical skills and further understand the primary care settings. I've always personally felt we should support IAPT as at the end of the day few applied Psychologists go into primary care settings (Lewis, 2013). Whether it's because they don't elect to or not is unclear but we can definitely support this through good supervision etc or just appreciate and understand the initial work they do if working in a non primary care setting.
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