Desperately seeking advice

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serintais
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Desperately seeking advice

Post by serintais » Fri Aug 17, 2018 10:17 pm

Evening everyone,

Apologies for the melodramatic nature of this post title, but I do feel somewhat desperate in that I’ve just taken up my second AP position and I never thought I would consider leaving an AP job after two weeks I’ll try and give the briefest breakdown possible:

I was offered the job with no job description, but promised over the phone that I would have some clinical work, supervision split between a CP and line manager and I would be helping with outcome measures in the team.
After two weeks, I haven’t received a login, supervision (like not even ten minutes...)or a job role. I have sat in on team meetings and nothing else.

From what I’ve heard the team I am in (a crisis team) do no clinical work, and all that has been mentioned thus far are audits and admin work. The person who offered me the job mentioned primarily working on outcome measures- however as it is a crisis team upon further investigation the team do not use outcome measures and do not believe they would be able to do so.

Now I don’t mind audit work, but I come from a really supportive role where I would work on multiple projects and clinical work all at once and I loved it- I have come home fairly upset the last couple of weeks feeling like I have made a terrible mistake and that this is one of those “bad” AP roles you hear about, especially seeing as the previous AP (there was a year between our roles) was also doing a lot of admin work such as reporting services. There have been all these suggestions made about some clinical work on the ward and in another team, but concern is they already have an AP, and getting scraps of work here and there is not what I signed up for.

I have been working on holding self worth recently, and honestly if I was brave enough I would tell myself I am worth more, I have skills which I can’t use here, and I don’t want to waste a year struggling to carve out a role where there isn’t one. On the other hand I read all these stories about people struggling to get AP roles and should I just suck it up?

At this stage... where I have literally received no support, no work, no job description and have been reading papers for the last two weeks, would you cut ties? It’s really REALLY getting me down as this is really REALLY not how I work as an individual.

Any advice welcome...

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miriam
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Re: Desperately seeking advice

Post by miriam » Fri Aug 17, 2018 11:00 pm

Doesn't sound like a dichotomous choice of suck it up vs leave to me. Why not speak to your supervisor or line manager, express that you are being under utilised and ask about the remit of your post? If it doesn't improve you can apply for other things and see if you are offered anything better. In the meanwhile take advantage of all this spare time and read!
Miriam

See my blog at http://clinpsyeye.wordpress.com

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ell
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Re: Desperately seeking advice

Post by ell » Sat Aug 18, 2018 11:58 am

As Miriam says, discuss this with your supervisor and go from there.

It's also not unusual for the first couple of weeks or so to spend the time shadowing and reading. It's more concerning that there is no job description and you haven't been properly told what you'll be doing once the you've done said shadowing and reading.

I wonder if the idea of helping with outcome measures is that you'll be helping establish them in the team? No mean feat if that's the case!

Hope it works out well for you.

alexh
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Re: Desperately seeking advice

Post by alexh » Sun Aug 19, 2018 1:29 pm

I recall feeling a bit of a loose end and being a spare part when I first started my AP role. No login, not familiar with the role and projects that were ongoing. It was especially bad as I overlapped with my predecessor who it appeared knew everything and everyone. The role was somewhat loose and ill-defined. My predecessor defined it in one way, I did it differently, with the help of my supervisor to bring my strengths to bear. It is not uncommon for trainees also to have slow starts to placements.

I currently work near a crisis team that recently took on some APs and have had and heard some discussions amongst the psychology network about the difficulties defining roles for them, letting them work within their competencies and not being pulled beyond them or into a generic crisis role, etc. Although this issue might be particularly stark in a crisis team, elements of role confusion and competency issues span many AP jobs.There's also some discussion of the AP role in an online crisis psychologists group at the minute, or at least the question has been asked: 'if you have APs, what do they do?' and not yet answered.
From what I’ve heard the team I am in (a crisis team) do no clinical work
I cannot understand this, what do you mean? What are they doing?

Have you come across this paper in your reading? "Clinical psychologists working in crisis resolution and home treatment teams: a grounded theory exploration" Murphy et al (2013). From my recollection, the dilemma you are facing 'how do I apply my psychology skills in this setting?' is shared by many crisis team psychologists.

Are you familiar with the UCL CORE (Crisis Optimimisation and RElapse Prevention) study http://www.ucl.ac.uk/core-study, and the framework they developed for benchmarking crisis teams, the CORE fidelity scale v2 https://www.ucl.ac.uk/core-study/workst ... y-scale-v2

I find the Structured Clinical Management approach to understanding crises (the SCM crisis cycle) very helpful, which is that crisis behaviours are perceived solutions to problems that are not effective, to be a very helpful way of introducing psychological thinking to crisis work. I see the crisis cycle sitting at the centre of a broader formulation of someone's difficulties. You may be able to find the Antony Bateman's SCM for BPD training slides online and read the crisis and admission sections. Edit: actually it's not that easy to find online, I will forward the crisis cycle if you pm or email me. It seems to me that in some crisis teams I have worked with they have no way of formulating and understanding crises psychologically so anything we can do to aid that is 'our work' and likely to be both difficult to implement and helpful.

I also do not think it is a case of suck it up or leave. Find a way of meeting with your supervisor as soon as possible, even if it is grabbing them for five minutes to share your worries in brief and then meet regularly thereafter. Shadow them to see what they do. Go out on some visits with the team (I assume the team visit service users!). Observe initial assessments and team handovers. Join meetings with or arrange to visit the main interface teams; the local CMHTs, MH wards, A&E liaison, Personality Disorder services, and possibly police. If your trust is geographically subdivided, visit the other crisis team(s).

Get networked with the wider psychology service at departmental meetings and CPD events, assistant groups etc.

During my current placement I conducted some focus groups with recent crisis team users, which was an excellent insight into what the team was doing well and what they could improve. That is one way of starting to think about measuring outcomes, service user satisfaction.

Bit of a jumble of ideas I'm afraid, I hope some are helpful to you.

serintais
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Re: Desperately seeking advice

Post by serintais » Sun Aug 19, 2018 5:01 pm

Hello all,

I want to thank all of you for replying with such encourageing suggestions. On reflection my reaction to these experiences following my first two weeks are definitely a reaction to having come from such a busy, supportive role in another area and I really felt the contrast in my new role.
Many of your suggestions such as shadowing etc I have certainly attempted albeit with a number of roadblocks along the way. However alexh, your reaponse has come followjng a weekend of rumination, and has been the final encouragement needed! I have decided to stick this year out, and perhaps I can shape my role within the team in such a way that it can pave the way for AP’s that come after me. My main concern, is ensuring I have access to some clinical work, and this is something I will need to be assertive about. I loved your idea of a focus group as it’s something I feel the team would respond really well to and I have organised these before. It was reassuring to hear that a number of crisis teams struggle with the role of psychology and something I can reflect on. And apologies when I meant no clinical work, I meant beyond the initial assessment in hospital ie no shorter term interventions as some of my reading had suggested they might do.
I still feel a bit lost and cast adrift, but motivated to strive on, be assertive and make things better so thank you all for your support :)

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ell
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Re: Desperately seeking advice

Post by ell » Sun Aug 19, 2018 9:15 pm

It's great you've been able to take that step back and reflect in stuff a bit. It did sound like a tough start! It's also nice to hear you feel encouraged to see what happens. But don't feel you have to commit to doing it for a year. If you find after a few months it's making you really unhappy, or it's just not proving valuable in terms of experience or using your skills, think about looking elsewhere (after talking it through with supervisors and trying to make it work of course!). What I'm saying is, don't put pressure on yourself to do a whole year if the role genuinely doesn't work for you.

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