Week in the life of a Clinical Psychologist- Child Specialty

How do we compare to other professions, what roles do we take, etc. Includes descriptions of "a week in the life" of relevant posts.
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Week in the life of a Clinical Psychologist- Child Specialty

Post by miriam » Mon Apr 09, 2007 6:34 pm

Qualified CP: What I do in a typical week

I've been asked about this a couple of times by private message, and it has also now been asked on a thread. It is also often something I get asked when I speak to people on the path to CP, so I thought I'd give a pen picture of what I do in a typical week. If I get a chance I will ask some friends and colleagues if they are prepared to do the same, and add them on later in the thread.

Monday:

I typically spend the day in the base for Children Looked After. Once a month, I go to a meeting where we review the children in all the local children's homes. On other weeks I consult with staff in one of the homes, or meet with young people there. They can be quite hard to engage, so I often do this informally by dropping in for lunch, chatting about TV or playstation games, etc. I sometimes attend school meetings, see individual children who are in foster or adoptive families or do one-off assessments, and I score questionnaires that we use to screen mental health needs. In the afternoon I supervise an AP (if I have one), and offer clinical supervision to two clinical nurse specialists who work with Looked After, Adopted and Vulnerable children. I'm also doing some research relating to LAC and attachment issues.

Tuesday:
I have cycles in which I offer (and then evaluate) a group to help non-birth-parent-carers learn about behaviour management in an attachment context. I often attend professionals meetings or case conferences. I try to catch up on admin (doing dictating, writing reports, preparing any teaching I am doing, responding to emails and telephone messages, etc). I sometimes do psychometric assessments of young people with complex needs, and I am collecting some of these for research purposes. If I can I try to read a paper or chapter relevant to my work - but I don't often manage it.

Wednesday:
I offer consultation appointments in the morning to professionals working with adoption, in a social services base. Normally I meet the social worker, link worker or other professional, but sometimes I do one-off sessions with adoptive or foster carers, or assessments of children to advise on their placement needs. There are usually two or three appointments, plus a short meeting with the permanence team manager. In the afternoon I do a joint clinic with a consultant psychiatrist where we consider cases where there is likely to be a neuro-developmental component, such as ASD. This leads to lots of follow-up psychometry. I see two or three cases in the joint clinic, using a room in the hospital outpatients department. Once a month we have a departmental meeting for child psychology at lunchtime, the other weeks we have a team/referral meeting for the mini-team that work with Looked After and Adopted Children.

Thursday:
I attend the MDT meeting, and psychology allocation meeting. Once every 3-4 weeks I get supervision from the head of department for an hour. I then see families in the afternoon. I normally schedule three or four appointments, these rotate between being a joint ASD clinic with the community paediatricians, a neuro-developmental clinic with a psychiatrist and joint MDT cases or individual therapy cases.

Friday:
I see clients for psychometric assessment and/or therapy follow-up appointments in the morning. Once a month I meet colleagues for a journal club/peer supervision over lunch (lapsed). I then spend some time keeping on top of my research and working on disseminating the results (at the moment this has been preparing and presenting it to various groups, working on papers for publication, seeking further funding). I also try to do some admin and respond to emails and telephone messages.

General
In amongst all of that I teach two days a year on a local clinical training course, and a similar amount on a local MSc course. About 4 times a year I teach an internal seminar, and I teach a few more days a year about ASD/Mental Health on rolling training programs. I also go to a few strategy meetings and professional groupings relating to my main areas of clinical responsibility. I'm also involved in the BPS network for CPs working with Looked After and Adopted Children and go to the national meeting 3 days per year, I occasionally go to the local SIG child meeting too. I probably spend 5 further days per year attending other training myself for CPD.

I generally work from 9.30am until 5.30pm. I have some flexibility in exactly how I configure my hours. My appointments with clients typically last around an hour. I guess you can see that I don’t do that much direct therapy, but to some extent that has been my choice. A lot of my colleagues do much more therapy by proportion. I do a lot of indirect work, and assessment, and multi-professional clinics, and teaching, and research, and something had to give! I think this is partly due to a particular pattern of demand within the service, and partly to do with my own interests. I do try to keep a few ongoing therapy cases as they can be quite satisfying and use a different skill-set. These tend to be based on CAT or CBT type models and be mostly teenagers. I review the proportions of different types of work fairly regularly in supervision.

I think almost all clinical psychologists do some supervision, consultation and/or teaching, so it is good not to forget about these skills when you detail your experience on clinical course applications. However the core work is often seen as the clinical role, both in terms of direct client work and indirect work. I think people naively assume that clinical work is only the face to face stuff, but I do assessment, formulation and intervention with clients I have never met in consultation with the professionals who are involved with them. It is the same set of skills, just applied to another person's observations rather than your own. You can also intervene in a systemic/organisational way, and be part of the clinical process (for example being involved in prioritising and allocating cases, based on a simple working formulation of what seems to be going on).

I forgot to say that (along with most of the other staff in our service) I am on a rota two or three times every month where I see young people who were admitted to the children's ward via A&E because of self-harm. The assessment is conducted the day after admission, once the person is physically fit for discharge to assess whether they are psychologically fit for discharge, and what kind of mental health follow-up is appropriate. If I have the capacity, and the issues the young person presents don't suggest a better match with someone else in the service, I like to follow up the young people who need therapy myself, as they tend to be very interesting cases.

I am on two strategy groups: one to develop regional standards for ASD assessment and diagnosis in school aged children, another to think about Attachment services, and how to increase thinking about psychological factors when placing children outside their family of origin, particularly in permanent adoptive placements. Oh, and I'm trying to write up several aspects of my research for publication.

It might be good if other people can post a day in their life onto this thread (qualified CPs) and if there was another thread to think about a day in the life of APs, support workers and other psychology graduate posts...

I'm sure I haven't covered everything, but that should give a bit of the flavour of what I do. If you have any questions, I'll do my best to answer them.

Here is a colleague’s description of what she does:

I work as a child clinical psychologist and what I do on a day-to-day basis can vary hugely. I do some work with Looked After Children (LAC), some work with children and families who are Deaf and some general child mental health work. The LAC work I do is often with staff or carers rather than the children themselves. This can be frustrating at times but is because LAC children have so many people coming and going from their lives that it isn’t necessarily helpful to have another one unless it is important. I work with one residential unit and go to their team meetings to talk about the children they have (and the difficulties the staff team have). A lot of what I do in that job is try to make staff, who often have no psychological understanding at all, start to think about why a child might be acting in a particular way. Occasionally I do some individual work with the young people themselves, but that generally tends to be assessment. I also do some consultation to people (at present only nurses) working with children in foster care. That is quite varied and what I’m trying to do is help the nurses and the foster carers understand where a child’s difficulties come from and what things they can do to help a child get past those. I could do that kind of work without ever meeting a child, but it can still be interesting.

I know British Sign Language and have an interest in children and families who are Deaf. That doesn’t make up very much of my job at the moment. I go to weekly meetings with the children’s hearing clinic and will talk with the staff about children they are concerned about. Sometimes it is only giving them ideas, at other times we will agree that I should see the child. That might be with a paediatrician or it might be alone. Most of the children who are deaf in Northampton don’t sign so I mostly talk to them usually my general clinical skills but adapting it slightly to take into account what I know about deafness. (For example, I would expect their speech development to be slower, to be more prone to abuse/bullying, to have a poorer level of ‘emotional literacy’, to find it more difficult to understand people when they are tired and therefore more likely to get frustrated). I also try to be aware of any children referred to the service who are deaf so that I can find out the information that the clinician’s need and make sure that a child’s deafness is taken into account.

The rest of my time is generally seeing children or families. I do a mixture of seeing families in our rooms, at home or at school. Mostly it is at our rooms though. The first time we meet I’ll meet with the whole family and try to get an idea of what the difficulties are, as well as the family structure and the child’s developmental history. That tends to decide what will happen next. I might work only with the parents to help them develop skills to help their child. I do quite a lot of work with children individually, and because I have an interest in younger children this often involves playing, drawing or telling stories. If I’m working individually with a child I’m often trying to help them develop strategies so that they can overcome their difficulties. This will often involve feeding back to the family and trying to develop conversations within the family because at the end of the day the child goes home and the family need to understand enough to help the child with whatever they are trying to do. I may also undertake some individual assessment with a child to see if they have any learning difficulties or disabilities.

The great thing about working as a clinical psychologist is that you are in a very privileged position and are often told information that no-one else in the family may know. The difficulties are that it is emotionally very demanding and that you get to see what I call ‘the dark side’ of life. Some people go through their lives without ever really believing some of that stuff happens in our world. As a psychologist you don’t get that luxury. Personally, I love what I do, and particularly love the variety of working with children. It’s a job I recommend, but realise that it isn’t the job for everyone.

In terms of what she said about seeing the dark side of life:

I think my view of the world has changed a bit. Sometimes I have to actively re-norm myself on the 99% of children who don't have autism, or the 98% of children who don't have developmental delay, or the 95% of children who have never been in the care system, or the 75% of children who don't have behaviour problems.... and I sure know the worst examples of what children have to live through, in terms of abuse, neglect, family dysfunction, and other adversity.

I guess it depends what you think of as most difficult. I see young people who have self-harmed and those who have terrible histories of abuse, but I actually find most of them really enjoyable and inspiring to work with (though on occasion I do get bad dreams full of child protection-type situations). It can be downheartening when things go badly for the people you work with (like their nice foster carer gets ill and they have to change placement, or their alcoholic mum starts drinking again after some signs she might be comitted to changing her lifestyle, or they are raped or mugged or something) and it does make you aware of many grim realities that other people can shut out of their consciousness. It can also be hard when you realise you need to stop trying to work with someone and make a child protection referral because they are harmful and unable/unwilling to change this even though they seem to love their child, or when you need to recommend that children are removed in expert witness work. It is also tough that we increasingly have to defend ourselves form complaints made by people we are trying to help. However, for me the most "difficult" aspect of the job is when organisational politics or awkward individuals block rather than facilitate your ability to work, whether that is a professional who constantly snipes at your practise in their correspondance, or a service that complain about lack of input but don't acept anything that you offer, or a colleague that is undermining rather than supportive in meetings, etc.

All of these are issues I would take to supervision (yep, six years qualified and I still make use of that hour a month in a very similar way to when I was an AP, though the sessions are less frequent and the discussions cover more management and systemic issues by proportion than clinical issues nowadays).

However, despite a very tough caseload and intense work pressures I am currently really enjoying my work and suffering delusions of competence!

I guess that it takes good supervision, and supportive colleagues, and family to absorb some of that, but it can be stressful if you let it get on top of you. Some people do seek out personal therapy, and others choose to gradually change their work over time to avoid burnout. I deliberately choose how I arrange certain clients over the working week to ensure that no one day is too overwhelming emotionally, and I also choose wind-down activities (like swimming after work once a week), but mostly I rely on having a very emotionally absorbent husband and best friend!

I know that my explanation of what I did in my job (a much sanitised version with no confidential information and much focus on resilience) to a GP I met at a party, once led to the host asking me to "please talk about something less sensitive as I had upset another guest"!!

A trainee told me: This is something we've talked about a lot in our PPD sessions on training - about how careful we have to be in talking about our work sometimes because what has become "normal" to us can actually be quite horrific for people outside of MH work. It's useful sometimes though to get that horrified reaction to remind ourselves that what we deal with is not normal and there are lots of families out there who function perfectly well and lots of children who are not harmed, abused, neglected etc. I find it particularly weird after a tough day on placement to go and pick my daughter up from a school where the majority of kids are clearly well nurtured and loved. It's a kind of reality check. I'm lucky to have several friends who do similar work to me so we have an informal peer supervision type thing going at times which helps.

Bluecat added her experince:

This is what I was doing five months into my first post after finishing training...

Firstly, what my job is - I am 0.5 into acute paediatrics based at a Children's Hospital and 0.5 into a multi-disciplinary CAMHS team. This week is fairly typical, although it doesn't really reflect the professional development aspects - we have monthly CAMHS training sessions for the four local CAMHS teams, and three-monthly CAMHS away days for the wider CAMHS network. Additionally, three-monthly Children and Young People SIG events, and the service has supported me to go to a couple of one day conferences.

Monday (paeds)

10.00-11.00 - Direct clinical Work - Younger secondary school aged child expreiencing asthma/panic attacks.
2.00-3.00 - Meeting with ward based nurses to elicit their training wants/needs to inform the training offered by psychology.
3.15 - 4.15 - Supervision.

Tuesday (CAMHS)

9.30 - 11.00 - Network Psychology meeting.
2.00-2.30 - Meeting with CAMHS nurses to discuss the anger management, anxiety, self-esteem groups run by the service.
2.30 - 3.30 - Direct Clinical Work - Older secondary school aged child with complex presentation including self-harm and stealing.

Wednesday (Paeds am/ CAMHS pm)

9.30 - 10.00 - Direct Clinical Work - telephone follow-up with parents regarding pre-school aged child with sleep, behaviour and toiletting problems in the context of poorly controlled epilepsy.
12.30 - 2.00 - CAMHS Team Meeting.
2.00 - 3.00 - Meeting with Team Psychiatrist to discuss the families and young people with whom we are working jointly.

Thursday (Paeds)

9.00 - 10.00 - Direct Clinical Work - jointly with supervisor younger secondary age child out of school despite having recovered from a rather nasty CNS infection. Highly anxious parents.
10.00 - 11.00 - First Assessment - Sixth form age child with recurrent disabling headaches with no organic cause.
11.00 - 12.00 - First Assessment - Pre-school aged child with toiletting problems in the context of Coeliacs disease and chronic constipation.
1.00 - 2.00 - General paediatric psychosocial meeting - multidisciplinary forum in which child protection and psychosocial concerns are discussed.
3.30 - 4.30 - Direct Clinical Work - Older secondary school aged child experiencing symptoms of depression and OCD in the context of having diabetes.

Friday (CAMHS)

9.30 - 10.30 - Observation of supervisor working with family.
11.00 - 12.00 - Supervision
12.00 - 12.30 - Meeting with Staff Grade Psychiatrist to think about how to work together with a younger secondary aged child with a tic disorder.
12.30 - 1.00 -Direct Clinical Work - Upper primary school aged child with complex presentation including mother with mental health difficulties, an unspecified learning disability herself, low mood, angry outbursts, and difficulties in school.
2.00 - 2.30 - Meet with Primary Care Mental Health Worker to discuss his visit to a particular high school regarding the young people I am working with who attend.
2.30 - 3.30 - Direct Clinical Work - Sixth form aged young person with chronic depressive state in the context of emotional abuse as a child and various other difficult experiences, some ongoing.
3.30 - 4.30 - Direct Clinical Work - Joint work with nursing support worker with a lower secondary age child with severe anxiety difficulties.

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Content checked by BlueCat on 29/01/2018
Last modified on 29/01/2018.
Last edited by BlueCat on Mon Jan 29, 2018 10:24 pm, edited 2 times in total.
Reason: Checked and title altered to be more representative

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