A Week in the Life of a Qualified Clinical Psychologist (Child) - ClinPsy.org

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A week in the life of a qualified clinical psychologist(child)

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 speakto people on the pathto 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. Oncea 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 healthneeds. 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 havecycles inwhich 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 thepermanence 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

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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 c linical 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 dont

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 colleagues 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 isnt 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

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present only nurses) working with children in foster care. That is quite varied and what Im trying to

do is help the nurses and the foster carers understand where a childs 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

doesnt make up very much of my job at the moment. I go to weekly meetings with the childrens

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 dont 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 clinicians need and make sure that a childs 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 Ill meet with

the whole family and try to get an idea of what the difficulties are, as well as the family structure and

the childs 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, drawingor telling stories. If Im working individually with a child Im 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 dont get that luxury. Personally, I love what I do, and particularly love the variety of

working with children. Its a job I recommend, but realise that it isnt 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 consc iousness. 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).


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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 c learly 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 s leep, 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


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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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