Week in the life of a Psychological Therapist in training

Information about the Improving Access to Psychological Therapies scheme, the different roles, training courses, professional bodies and the KSF requirements.
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Week in the life of a Psychological Therapist in training

Post by baa »

I am a Psychological Therapist (aka High Intensity Worker) in training in an IAPT service. I've been there for four months and have just finished my first term of my PG Diploma in CBT/High Intensity Interventions. Previously, I was a Psychological Wellbeing Practitioner, and before that an Assistant Psychologist for four years. My typical week involves two days at uni and three in practice; I see about ten clients a week. My clients are usually people who are experiencing moderate depression and anxiety (including panic disorder, social phobia, obsessive compulsive disorder, body dysmorphic disorder, health anxiety, generalised anxiety disorder, and post traumatic stress disorder).


I get up at 5:30am and drive to uni, we have a full day of lectures – 9-5. It's a mix of lectures, group activities and the ever-present role play. I've just finished a term on The Fundamentals of Cognitive Behavioural Therapy – so history and theory, assessment, general techniques (behavioural experiments, cognitive restructuring) as well as teaching on the different levels of cognition (negative automatic thoughts, dysfunctional assumptions and core beliefs) and how to work at each level. Next term is all about the anxiety disorders – one per week! The third and final term is all about depression.

Monday night I spend at uni in student accommodation, it's a bit like one big flashback to 2000. I usually spend that time sensibly locked in my room reading, preparing for supervision or completing assignments. Occasionally I escape and spend that evening in the local pub with some coursemates.


More lectures again! Usually on the same topic as Monday. Then a quick lunch and off to supervision. I have group supervision – four of us in a two hour slot with an accredited CBT Therapist. This initially was slightly alarming and set all my NATs off, however, it's actually been really valuable and I have a lovely supervision group. We have to prepare a specific supervision question, in order to make best use of our time slot. We've also been ordered by the BABCP (British Association of Behavioural and Cognitive Psychotherapists) to play our session tapes in supervision, so now I'm fully aware of my range of verbal tics. This is also helpful given that we have to hand in six sessions to be marked using the CTS-R (Cognitive Therapy Rating Scale – Revised), an evil scale that is used to rate therapy sessions on millions (twelve) of aspects of CBT; agenda setting, collaboration, eliciting cognitions/emotions/behaviour, homework setting and so on. After supervision, we have journal club – discussion of a journal that we have read (usually on Monday night) and how we would translate this to practice. Next term this will become case discussions; each person will get the chance to present a client they're working with. I will probably present someone that I'm planning to write up for one of my three case studies. We finish all of this at 5pm, so I drag myself back home and fall asleep.


Back at work!

First, we have an assessment feedback meeting; a time to discuss the assessments we are unsure of. The team then decides where this client is best placed either within IAPT or in another team. We have good links with some sections of secondary care, less so with others! Short break and then straight into the team meeting. Then I get a two hour slot where I can prepare another supervision question, plan sessions, and make any phone calls that I need to make. Off to supervision with an accredited CBT Therapist, it's group supervision again. This has it's upsides and downsides, I get to hear about other people's clients' and how they work with them, but it means I only get a half hour slot – which is viewed as an hour by the BABCP. My supervisor is supervising seven other Psychological Therapists and eight Psychological Wellbeing Practitioners, so until we have another qualified worker, this is the way things are. Once that is over, more planning of sessions and emergency reading for all the people I am stuck on! Then every month at 4:30 I have management supervision.


9:30 - Assessment session with a client with low self-esteem, they had six sessions with a psychological therapist previously, but felt that this wasn't enough. I read Melanie Fennell's work on Low Self Esteem a few weeks ago, so attempt to hold this in mind during the session. From the sounds of it, this model looks like it will be extremely helpful, given that the client is describing a mixture of anxiety and depression with a rather prominent Bottom Line of “I am stupid/worthless”.

11am - No client in this slot so I went for a wander to introduce myself to some more GPs, one didn't realise that the PWP and I were actually in the surgery yet. So it looks like we'll be getting a whole load more referrals soon enough.

12:30 – Again, no client. So I read about Obsessive Compulsive Disorder and fret about my next client.

2pm – Client with long-standing OCD. We talk through one of her maintenance cycles in the session and she plans to fill out more for the other obsessions/compulsions for homework.

3:30 – Last client of the day. A man with Body Dysmorphic Disorder. Together we've come up with a vicious flower formulation as he has a whole host of maintenance cycles reinforcing his thought of “I'm ugly/inferior”. We started on the mirror gazing and will be moving onto him comparing himself with others.


Off to my other GP surgery.

9:30 – First client is a man with depression. We're starting off gradually with behavioural activation, trying to figure out what he would see as a balance between doing nothing (as he has been for the past six months) and doing everything (as he had been doing for the previous five years!).

11 – Second assessment session with a client with chronic pain, relationship difficulties, depression, and now I discover that they also experience panic attacks and possible health anxiety. I plan to start on the depression as the client highlighted that that was where they wanted to start. They find it really difficult writing anything down, and were freaked out by the guided self help material. So I bin the usual behavioural activation diary and we agree a system that is workable.

12:30 – An appointment cancelled by a client with no telephone. My surgery is in the middle of nowhere, so I also have no mobile phone signal. I catch up with notes on PCMIS (electronic note system) and chat to the District Nurses.

2pm – I'm putting together a formulation with one of my clients, I'm trying to demonstrate the links between the client's horrendous childhood and their self-esteem in the current day.

3:30pm – Last client of the day. A new client who has experienced depression since their early teens.

Saturday: I work on my essay between about 3 and 5. I do have study days during University holidays, however this doesn't link up well with all the assignments that are due in in the middle/end of each term! So my weekends have kind of vanished. I don't study on Tuesday nights (too dead) or Friday nights (just ain't happening), and try not to work on both days over the weekend, but it happens when I have multiple assignments due in.

Sunday: Spend most of the afternoon working on my essay, reading an article for journal club and then listening to a tape of one of my assessment sessions ready to hand in to be marked using the CTS-R. I have to draw up a formulation, rate myself using the scale and write a reflective analysis.

I love this job, and love CBT. I'm planning on staying as a Psychological Therapist for a decent chunk of time.\,so I'm not planning on applying for the Clinical Psychology Doctorate any time soon! My interest has always been in the clinical work, and since working as a PWP, I've decided that CBT is the approach for me, so I don't really see the need to train in other approaches at the moment. I should be qualified in May 2011 and will be able to apply for accreditation with the BABCP. The training is intense, and I would cheerfully murder someone in order to have study days when I actually need them. I have had to be really careful about seeing friends/planning in activities that aren't uni related. Despite that, it's definitely the right choice for me.

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At least I'm not as mad as that one!
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