Unspoken challenges of clinical psychology training? A view from inside. PART 1

Becoming a clinical psychologist has been likened to a process by which a new identity is incorporated into an existing sense of self whereby unique physical and mental experience, attributes, and a position within social roles, relationships and discourses is transformed. This process, although rewarding in the main, is not experienced without challenges and pain. What one might struggle with on the professional pathway is to some degree personal and idiosyncratic nevertheless, some processes may become engaged and/or significant for many. Further, often it is the things we do not expect to find difficult that come and pose the most challenges. This post aims to present some of the processes and dynamics which can become challenging for trainees within the professional socialization process. Those who are aspiring clinical psychologists or new trainees may find reflecting on some of the issues it highlights helpful. Hopefully too, it will be of some use to those with supervision responsibilities.

Feeling deskilled

Feeling deskilled at the start of training or learning journeys is a common experience. However, in the context of clinical psychology training such feelings may well become amplified. The demand for clinical psychology training places has always outstripped the supply. The possible difficulties trainees may have faced to gain places due to the inherently competitive nature of the recruitment process may bear an influence on the professional socialisation process. Trainees may feel pressured to ‘prove’ that they are deserving of a training place or that they are good enough. Unsurprisingly, many will come to experience self-doubt, some loss of confidence and even ‘impostor syndrome’ during the training journey.

The Conscious Competence Ladder model (Burch, 1972) may provide a helpful framework to better understand and reflect on how trainees may respond to learning processes and activities. This model essentially posits that two factors: consciousness and competence, affect our thinking and emotions as we acquire a new skill. According to the model, we move through four different levels or phases as we build competence. The initial level: ‘unconsciously unskilled’, occurs when we do not know that we are not competent. We then move onto the ‘consciously unskilled’ phase as we realise the limitation of our competence.

Thirdly, it is posited that we become ‘consciously skilled’ when we are aware that we have acquired the skills/ competence required (though conscious effort is still required). Finally, the ‘unconsciously skilled’ level is reached when the said skills and competence have become so assimilated that they demand little or no conscious awareness to be practiced. This model is not linear and we may for instance after having become unconsciously skilled, revert to feeling consciously unskilled for instance because we fail an assignment. Of particular relevance, training wise, may be the fact that trainees are required to complete placements in different specialized areas and thus may recurrently find themselves in the consciously unskilled phase, the most emotionally demanding position; as they develop their competencies.

Managing power imbalances

We all have peculiar relationships with power and authority based on various factors including: our personal history, our cultural and social backgrounds and to some degree our social positioning. In addition, how we may deal with potential feelings of disempowerement and powerlessness can also be related to professional experiences and in particular, the level of past autonomy, responsibilities and/or organisational cultures accustomed to prior to starting training. Whilst for most ‘traditional’ applicants gaining a training place will entail an increase in status and with it an improvement in terms of employment and work conditions, for those who held relatively senior posts and worked autonomously before starting training, the training environment and trainee role may take some adjusting to and indeed involve a decrease in status and in autonomy.

Trainees can often (though mostly tacitly) be positioned as naïve, dependent and/or passive. Such implicit infantilisation can occasionally become explicit. On one occasion, for example, the positive feedback from a placement review I received included ‘doing as I am told’. Clearly, the supervisory relationship is not an equal one as clinical supervisors hold evaluation and marking responsibilities and thus have actual power (to pass or to fail) over the trainee. An unusual dynamic may be created when trainees because of their past experiences/responsibilities, qualifications and/or behaviours may not meet some supervisors’ potential expectations of dependency. Whilst actual power may not be disrupted, for some, perceived power may well be.

Power dynamics are of course further complicated when trainees belong to minority and/or marginalised groups. Their presence in the training arena alone can challenge or evoke social/personal expectations and stereotyped notions. Self-fulfilling hyper-vigilance may thus become an issue for such trainees who may become anxious about the (real) possibility of being discriminated against or of facing prejudicial attitudes. On the other hand, difference may also impact on some supervisors who may not have prior experience of working with ‘non-traditional’ trainees and who may be unsure about how and whether or not to raise issues of difference within the supervisory relationship and/or be unduly preoccupied with the (also real) eventuality of being perceived or experienced as prejudiced.

The challenge of adopting a questioning attitude

Clinical psychology trainees hold dual statuses as trainees thus, employees of specific NHS trusts which usually provide an employment contract, associated terms and conditions and the placements within which practical skills are developed and; as students within universities which host the courses, deliver the academic components of the training programme and thus the student identity. With the professionalization of the discipline, the adoption of the trainee role over that of the student one seems to have been preferred. Such preference would appear to give higher status to the trainee role.

However, the exclusion or reduction of the student identity may set particular dynamics and impact on how trainees see themselves, their learning and how they are perceived. Whilst students may be actively encouraged to be questioning and irreverent toward prior practices, theories and of taken for granted wisdom, such a stance may not be specifically sought after or strongly emphasized within the trainee role, arguably necessarily so. Indeed training is, by definition, centred on applying and demonstrating practical competence often by copying or mirroring others.

Given the unbalanced power distribution and the potential high risks of getting into conflict with those who hold a responsibility for assessing you, it is perhaps unsurprising that trainees often simply decide to ‘go along’ with theories and models of working that are experienced as oppressive, are incongruent/incompatible with their worldviews or appear to lack empirical support. Additionally, people in cohesive groups typically experience greater pressure to conform than those in non-cohesive groups. Consequently, homogeneity and conformity may not only present challenges for trainees, they may problematize innovation and creativity within the profession (more on that in due course).

Thank you for reading, If you have found this article useful or interesting, please spread the word.

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