Careers: Follow what you believe in

Perhaps the first question I asked Dr Michael Sinclair was intrusive. 'Given that you look so young, how do you do so much?'

Michael is a Chartered Counselling Psychologist and the Lead Consultant and Clinical Director of City Psychology Group, which offers psychological services predominantly to senior executives and occupational health departments in blue chips. His path to that position takes several paragraphs on the group's website – and that's just a summary. He's worked in both the NHS and the private sector in schools, specialised mental health clinics, GPs' surgeries and hospitals.

He answered. 'I just keep going. I'm passionate about psychology and what I do, so I try to get as much experience as I can. In my view, basic psychological theory can be applied to many different areas and can often offer solutions to many practical problems. So, I jump at every opportunity. The research and application of psychology is about making a real difference to the successful future well-being of ourselves and of this planet. We look at ourselves in the mirror – some may say that's vain, but let's face it, we are fascinating creatures.'Michael tells me the keys to his career to date have been 'compassion for and connectedness with clients, curiosity about people in general, accepting my limitations together with always delivering on my promises. That's not to say it's been an easy ride – it's involved hard work and scary risks, but I have always followed what I truly believe. Even when the road in front of you seems to be completely dug up, you persevere, don't give up and find an alternative route towards your goals and values. Work–life balance has been an issue, and I have had to rein myself back! Along the way some fantastic colleagues have been invaluable when telling me it's time to take a break!'

A fundamental optimism

As well as his managerial and supervisory responsibilities, Michael spends most of his time in full-time private psychological therapy practice, working with people of all ages, couples and families. After some thought he can put his finger on why he first studied psychology. 'I liked the role of objective and empathic observer. I used to watch members of my family and wonder what motivated them. But the real catalyst was a book – Desmond Morris's Manwatching.' Morris trained a a zoologist and his approach, firml based in zoology and ethology, was hugely influential in the 1960s and '70s 'I became fascinated by that book.'

Once Michael had achieved graduate basis for registration, how did he decide which area of psychology to specialis in, given his many interests? 'I attende a brief course in counselling while at university and started reading a lot of books on therapy. I became particularly captivated by Carl Rogers and his book On Becoming a Person: A Therapist' View of Psychotherapy. That was it I was hooked and knew that that's wha I wanted to do'.

Michael describes his work in the Psychology Unit in HIV Medicine at The Royal Free Hospital as 'crucial experience. The department provided services to a very diverse population. It really brought home that I wasn't just dealing with health but with wider issues, including family and culture. And it also gave me a fundamental optimism: that people could move forward even in the face of such adversity. I think you need that basic belief.' Michael continues to be interested in health psychology and the psychological impact of illness and also medically unexplained physical symptoms; he has just recently published a related academic paper on his research in Counselling and Psychotherapy Research.

Michael works alongside and supervises people from a number of different psychological disciplines, andhe says that 'while there is a common underlying theoretical base which applies across different sorts of practice, there is a need to understand what each area uniquely offers. Counselling psychology is a scientific practice and a "way of doing psychological therapy" in its own right, though it's probably less understood than other applications. It has its roots in a holistic and humanistic understanding of people and their problems. Thus, to some extent, it resists the pressure to adopt the medical model, which can be limiting, underlies much policy and is a foundation for many clinical approaches. Counselling psychology focuses on the therapeutic relationship – the psychologist is part of it, not sat on one side. The therapeutic relationship is paramount to the successful outcome of psychological therapy, over and above the application of any particular treatment paradigm.' Michael is, among many other affiliations within the Society, a Practitioner Member of its Register of Psychologists Specialising in Psychotherapy, an interest that obviously informs his practice.

Since he began his training, Michael has seen counselling psychology becoming better understood and represented as an equal and respected subdiscipline of the Society. He works with other types of psychologists and although he believes that 'there is still some way to go with this, the most helpful attitude is to see how different approaches complement each other rather than do battle!'

Private practice – pros and cons
Since Michael has worked both privately and in the NHS, I asked him if there were any differences between the two environments.

'Although I have worked solely in private practice for a number of years I still keep close connections with the NHS. There are pluses and minuses to both situations. You're freer when practising privately: there's less bureaucracy, less emphasis on the medical model I mentioned earlier. You can investigate and be experimental. Coming from the NHS, I initially thought that doing therapy privately would be all about "tea and sympathy", working with bored housewives that may have ironed one shirt too many, but that is not the case. I work with people presenting with the full range of clinical issues, from mild to often very severe.'

Michael does admit that practising privately has its downsides. 'You nee a great sense of responsibility around duty of care, with no large organisation, like the NHS, to watch your back; it can be lonely and you need to make an effort to connect with peers and ensure that you have a multidisciplinary network of colleagues close by. Supervision and CPD become critical. Establishing yourself as a private practitioner can be tricky, there's a lot of competition and you have to work hard to ensure that you not only survive but thrive. There's still some prejudice against private practitioners, though this has reduced hugely since I started. And in fact a lot of the psychologists who work at City Psychology Group initially worked for the NHS before joining us. It's great to hear of the developments around establishing an Independent Practitioners Forum amongst Society members also'.

You're there to deliver for them
So, how did the City Group develop?

'I worked on my own at first. I had a Harley Street office. It's hard at first, and there is a lot of trepidation around work not coming in. But in time I was getting too much work – it came by word of mouth. The practice grew from strength to strength, we gave it a name and it became obvious we needed other offices in Liverpool Street and Canary Wharf. Although psychological therapy has and will continue to be the backbone of City Psychology Group, it has developed into a more comprehensive psychology service including a specialised child and adolescent department and psychometric testing, medico-legal and corporate training services. We have quite a few further projects in the pipeline right now; it's a very exciting time.'

Working with very senior executives must make different demands on you. 'They can have very high expectations around the outcome of therapy but often strong motivation. They believe that you're there to deliver for them, to fix the issue they've brought to you. Once you get in front of them they come through loud and clear. They are often high-functioning and intelligent individuals, which brings both an interesting challenge as well as the basis for stimulating therapeutic conversations.

I think that the real suffering of this client group is still much misunderstood in wider society, due to their financial income and recent unfavourable attention in difficult economic times. I feel passionate about working with this client group and helping to make a real difference for them despite the unfavourable attention I also receive in doing so. The truth is that, despite their career choice, they face very real and excessive demands, and a whole host of psychological problems can arise if they become "institutionalised" within their corporate world. Stigma around mental health is rife in their competitive work environment. They tend not to open up and talk freely about their distress for fear of being the next one given the redundancy chop! Despite feeling unwell, they often work too hard for long hours. This understandably exacerbates their psychological problems – somatic complaints are very common, as is the full spectrum of anxiety disorders, depression, and some suicide attempts. Many adopt some very unhelpful coping strategies instead.'

Michael says he works with the senior executives and CEOs that come to him to 'make sense of their situation. I help them to rebuild self-confidence and return to their work environment if that's what they chose to do, which is sometimes not the case after therapy. In consulting with employers, I often tell them that failing to recognise and accept the limitations and fallibility of their employees will undoubtedly breed fear, increase level of stress and ultimately incur significant health and financial costs for their businesses. Putting it in financial terms often helps employers realise the benefits of implementing strategies to safeguard against work-related stress at both a preventative and management level, and to break down the stigma of stress in this highly competitive environment.'

Their expectations about therapy must put pressure on process, which is a critical issue in the counselling approach. 'High expectations are also driven by limitations on funding for psychological therapy – whether a client is self-funding or using private medical insurance, they expect results in a timely manner. We do use brief models of psychological therapy, but that's not about putting people through a sausage machine and "solving" a particular problem in one 30-minute session. I have worked with some clients over years. What is important is that you use the time well. It's not about how much time you spend with a client but what you achieve in that time and the quality you bring to the therapeutic relationship – a productive, unique and rich experience.'

We have a duty to explain
In addition to academic publications and presentations, Michael appears regularly in the media contributing to newspapers, magazines and TV and radio interviews. He also publishes books; one recently on mental health and coping in the workplace.

'We have a duty to explain what we do to a wider public. Working privately, most of your feedback comes from clients. Writing and communicating more widely solicits more feedback. And you also find you have things you want to say which don't fit into client sessions. So, writing has become a sort of self-therapy – counselling can be stressful and writing gives release.'

Michael has just finished co-authoring another book for publication; a step-by-step CBT workbook. 'It will stress how CBT techniques can help you all the time, not just when you're feeling unwell or think you need help. There's often a stigma associated with mental health problems, counselling and therapy, and it's not helped by the prevailing medical model. With some clients you have to help them overcome the feeling that they're being indulgent. You don't – or rather it's unwise to – wait for a heart attack to think about your smoking habit. You don't wait for your car to break down to get it checked out – that's what MOTs are for. Why wait for mental health problems to appear before actively helping yourself or talking to someone about your problems? CBT and other evidence-based techniques can continue to contribute across an individual's life to promote their well-being irrespective of whether they feel unwell or not. My sister died suddenly last year, which has been an incredibly traumatic experience – if I didn't practise what I preached, I wouldn't be fit to talk to you right now.'

The future is promising
Michael ends on a positive note. 'Younger psychologists seem more confident. The profession seems to be more understood, partly because of media coverage of psychological issues. We shouldn't be scared of that exposure – it's allowing us to get accepted by the general public and have more impact. Furthermore, with the growing popularity of third wave therapies such as acceptance and commitment therapy and other mindfulness-based approaches, the future of therapy is looking very exciting'.

'I resist being put in a box'

Julia Busch Hansen is an independent Chartered Educational Psychologist with strong professional ethics and a child-centred approach. Ian Florance set out to map Julia's route to independence.

My sister did her teacher training at the Fröbel Institute and I realised how much psychology was required in teaching I was reading psychology at university, an it was then I knew I wanted to be a career psychologist. Before that, I didn't know about the career path! I was slightly taken aback when I realised I'd need to commit
10 years to becoming an educational psychologist, but I made a conscious decision to carry it through. My degree was in London, then I did the PGCE in Bristol. Specialising in working with nursery/infant children, I decided quickly that I had two roles – teaching children and supporting parents. I gave a lot of my time to informally advising and helping parents – my headmistress noticed this and gave me the opportunity to work across a much wider age range as well as giving me the new SENCO role.'

The systemic approach you mention on your website obviously started there. 'Yes, but it also goes back to a peripatetic childhood. I travelled with my parents, went to school in many countries, and it quickly became clear how much different environments affect the roles of parents and children.'

An apprenticeship
Julia worked in the old Inner London Education Authority in Battersea, then wanted to do her master's. She was intent on going to the Tavistock Clinic. 'It was fiercely competitive, with a two-day interview, but I was drawn by its multidisciplinary and systemic approach. It was more like an apprenticeship. You had to work while you studied: that was invaluable.'

At that time, educational psychologists used to complain about the narrowing in their role to assessment and special needs statementing. At times, teachers expected to be able to refer children to Special Educational Needs Coordinators (SENCOs) who would deal with difficult issues 'I always had a more proactive attitude with
a mission to always do more than statementing. I used to hold coffee evenings for parents and tried to stress inclusive responsibility for children. I involved non-teaching staff as well as classroom teachers and specialists in implementing our strategies.'

Julia worked for her Chartership in Inner London which gave her a wide range of experience. She then moved to Suffolk, 'Where I was the youngest in the team, but my experience with much younger children was, I believe, a huge advantage. I learnt how to teach a child to read, which many secondary colleagues had to ask my advice about. We deal with an age range of 0 to 19 as generic EPs. Although in my independent work it's more like three to16 years, with counseling for the 16+. I might offer counselling for older teens on behaviour management, for instance, and assess a three-year-old for gifted and talented in the same week.

'I introduced brief therapy in Suffolk, an approach pioneered in the USA for clinical and forensic applications. I'd attended an independent course on the approach, whilst I was training at the Tavistock Clinic in London. You had one, and only one, appointment with the client and then moved them on.'

Setting up her own school
By this stage Julia had her own family – a daughter and a son – and was disillusioned with nursery provision in her own area. So she set up her own nursery school. 'It was a community project based in an old church reading room. I was working as a part-time educational psychologist, but this venture gave me the opportunity to teach children without special needs. That's invaluable – any educational psychologist ought to have that experience. Putting my professional experience together with the fact that I was a parent gave me a lot of "street cred" and I was able to influence the curriculum – no reading schemes for instance. I think early years education is about helping children to learn how to learn, not to be hemmed in by a prescribed curriculum. In order to link this work with my role in Suffolk County Council, I set up a group known as POPEYES (providers of private early years education in Suffolk) which linked the various types of pre-school provision where parents could spend their nursery voucher.'

Moving to Abu Dhabi
Family life also influenced Julia's next move. 'My husband is a consultant. He's been hugely supportive, but his work takes him away a lot and our son began to "imprint" on neighbours! So, we went as a family on his next posting to Abu Dhabi. You require a sponsor to work in the Middle East, and at first my husband fulfilled that role, but I needed an Arab sponsor. I got an introduction to the education directorate and went there on my own. Arab culture is very hospitable. They didn't quite know what to do with me and I was handed round like a hot potato but, after a lot of – very wonderful – coffee, I was handed a "no objection" letter, which meant I could become the only educational psychologist in the Gulf. I worked with all English-speaking schools, assessing, counselling and advising.'

Julia set up a group – roughly translated it was called 'The House of Generations' – with a Canadian counsellor, offering systemic approaches to family issues 'We had an office, counselling rooms and employed other professionals, such a a speech and language therapist. It wa a dream situation so, when it was time to move here with our family, I found a UK educational psychologist to take on my patch in the Gulf. She overlapped with me for a week for me to introduce her to al my professional contacts, as the Arab world very much relies on personal introductions.'

New ventures
Five years ago Julia moved to the New Forest, to the house where her husband grew up. She then set about creating a new business, though 'I'm not a businesswoman. In the UAE we got paid on the day of service delivery, which made things easier both from the point of view of cash collection since finances then didn't impinge on or distort what therapeutic service you were offering. There are more educational psychologists in Hampshire than in Suffolk, and initially my work came the old-fashioned way – by meeting people and by word of mouth. I always stressed to parents who came to me that schools must be involved and that teachers must contribute to the assessment. This ensures they will pay attention to what I say and act on it. So, gradually I developed a network of schools that I work with – all within a two-hour car drive radius. I'm pleased that I'm increasingly getting involved in INSET.'

Julia says her website, a relatively recent development, is 'designed to take the mystery out of what we do. Parents don't really understand what educational psychologists do, so I thought the site should be explanatory for teachers and SENCOs to pass on to parents.'

Inevitably, given Julia's track record, there is another string to her bow: 'Horses. I love working with horses, and I want to use "natural horsemanship" as a means of human self-discovery with children. Asking clients to communicate with horses – getting them to move or not – teaches us a lot about communication.'

So, what do you think sums up your attitude to psychology? 'I hugely resist being put in a box. You can apply psychology in so many different creative ways, in many different contexts.'