‘Connection with another human being is at the heart of the job’

I stumbled into becoming a psychologist. I had no idea what I wanted to do when I finished my BA in Psychology and Sociology at Leeds University. Following my graduation, I was offered an interview at a teacher training college in Liverpool, but I went to the wrong college and missed my interview. A close shave – I could have been a teacher for 37 years!

Two days later I bumped into a fellow student, Brian, in the Leeds University student bar. He had just obtained a job as a psychology assistant at Moss Side Special Hospital treating sex offenders. His lurid stories all sounded rather more interesting than teaching. He generously gave me a small piece of paper which he had prepared earlier, with a list of hospitals that were looking to employ psychology graduates. That piece of paper changed my life.

Within four weeks I was working in an adolescent unit therapeutic community in Macclesfield, playing football every day and living in a nurses' home – what fun! A year later I obtained a place on the two-year Surrey University MSc in Clinical Psychology course. My final placement was at Broadmoor Special Hospital, which triggers memories of walking around with a huge bunch of keys. I remember the summer of Ian Botham's cricketing heroics against the Australians at Headingley, listening to the score on the radio in the wooden canteen just outside the high walls of the hospital/prison.

Towards the end of that placement, there was a job vacancy at nearby Fair Mile Hospital, an old Victorian psychiatric hospital in Berkshire, halfway between Reading and Oxford. The Head of Psychology at Broadmoor, Tony Black, knew the service and hospital, describing it as 'a sleepy hollow', which sounded quite attractive to me. I started work there in October 1981 and have been in the same district ever since, apart from a couple of sabbaticals for travelling around the world and working in New Zealand.

What's changed over 37 years? 

Let me paint you a picture of my working life when I started. There was a grand total of six clinical psychologists in West Berkshire, four men and two women, who all used to meet on Wednesday lunchtime, in the district psychologist Wynn Lloyd's office, in Borocourt Hospital. Wynn would puff away on a small cigar, while we sat around discussing the issues of the service. On my first day, I was issued with a regulation black Echolac briefcase, with combination lock, which contained a full Wechsler Adult Intelligence Scale (WAIS) and a collection of the Rorschach inkblot cards, which I carried around with me.

Now, all the old psychiatric and learning disability hospitals, Fair Mile and Borocourt, which used to be the hub of services, have closed down and been transformed into luxury flats in the Berkshire countryside. Yet these days, the number of psychologists in the district must have increased by at least 10 times, or even more if all the IAPT talking therapy staff are included. And whereas in that smoky room (now banned) the men outnumbered the women two to one, for the NHS as a whole it's now 78 per cent women and for my Trust (BHFT) it's 83 per cent.

During my time, the world has developed specialism. The age of the generic psychologist, medic, or lawyer is dead. Back in the day, in the course of a week, I might carry out a neuropsychological assessment for dementia on a man on a psychiatric admission ward, then might run an anxiety-management group in an outpatient clinic, visit a head-injured patient in the general hospital, then run an outpatient clinic seeing clients with eating disorders, a personality disorder, and post-traumatic stress disorder. In fact, I remember seeing people from the Hungerford shooting incident and the Paddington rail crash. Now there are specialist Trauma, Eating Disorder, Neuropsychology, IAPT, Health Psychology, Inpatient, Early Intervention in Psychosis, and Older Adults Services. There do not appear to be any Psychology Departments any more, with most psychologists working in multidisciplinary teams.

We are no longer just 'testers' assessing people at the behest of psychiatrists. In fact, the vast majority of psychologists can leave a three-year clinical course with little knowledge of psychometric testing. Instead, there has been an acceptance that psychological therapy, of the CBT and third wave types of therapy, ACT, DBT, MBT, etc., where there is some structure and expectation that the client has to try and make some change, can be helpful.

The NHS and private sector has, in my view, become much more obsessed with risk. About a year ago I went to a talk by a senior nurse in our NHS trust who stated that 'our jobs are all about managing risk'. I am not sure I recognise that my job as a psychologist is all about managing risk. I'm not a parent, but someone who wants to facilitate independence and wellbeing. I complete electronic risk assessments with little faith that they actually make much difference. (And while I'm on electronics… with the advent of computers, electronic notes, emails, voicemails, mobile phones, the world has become faster and more bureaucratic. In those days I might have a couple of letters to slice open with my paper knife, at a leisurely pace… now I have 60 emails a day to harvest, plus letters, plus voicemail. We are all being overloaded.)

What have I done? 

I often think I would have liked to ask my great uncle what it was like in the trenches of the First World War, or to ask my granddad what it was like to work in the Austin car factory. If one of my grandchildren or great grandchildren asked what I did, this would be my description.

The job itself is a unique mixture of head and heart, a mixture of academic knowledge and interpersonal skill. When I used to volunteer to go to the children's school careers fair and people would come up to me and say, 'What skills do you need to be a psychologist?', I would say it helps to be curious about people, nosey, to be interested in what makes people tick.

It also helps if you genuinely like people. We have the unique privilege of meeting people, in a very intimate manner, and listening to and sharing their innermost secrets, their inner world, trying to help them understand themselves better and to devise a map or plan so they can move forward in their lives – ultimately to alleviate psychological distress and increase wellbeing. I have been fortunate enough to see thousands of adults with mental health problems, acquired brain injuries and neurodevelopmental problems such as autism or ADHD. Connection with another human being is at the heart of the job. I can recall certain patients who changed the trajectory of my career; a man called Brian who was totally amnesic after a viral encephalitis, Lindsay, a young man with a brain injury, whose mother founded the charity I was to end up chairing for 30 years; a variety of stressed executives; a man called David who had Asperger's syndrome and various mental health problems; and all those hundreds of people with anxiety and OCD.

Inevitably, there's management stuff too. As psychologists, we are in a unique position to be able to develop services. I recall being the only psychologist in Berkshire interested in neuropsychology, and early in my career I got involved with patients that general psychiatrists weren't really interested in. These included a number of young head-injured patients, sent out of county to specialist private units, and a man with a severe amnesia. Being useful and bringing some of those people back and helping to sort out a suitable placement for the amnesic man, meant that some of that saved money funded some sessions of my time. Since then we have developed a community neuropsychology service, initially for people with brain injury, then for people with neurodevelopmental difficulties, such as adults with autism and ADHD. There are now 10 neuropsychologists – most part-time.

I have also been chairman of the charity Headway Thames Valley for 30 years and enthusiastically endorse partnership working between NHS and the not-for-profit charity sector. In that capacity I've been fortunate enough to meet Lady Diana, Stephen Hawking and the Prime Minister. Some people see the NHS as a battlefield, or an obstacle course, some a business, whilst other people see it as a playground. I have to admit my view has been more towards the playground model, because it's been fun developing services, meeting challenges and working with friends, colleagues and teams. I also had the privilege of building up a psychology service in a local community mental health team for over 20 years.

I've been fortunate enough to work in a Trust where I've written six books (see below). All have intended to translate complex ideas into a simple language that my mother could understand. I've also carried out and had published a number of small-scale research projects, including evaluating anxiety management groups in routine clinical practice, looking at the effects of minor head injury, examining post-traumatic growth 13 years after severe brain injury, and looking at the emotional effects of getting a diagnosis of ASD in adult life. Most of my writing and research has been squeezed into a Friday afternoon, although when I've had a project on the go, it provides me with a form of mental chewing gum, improving clinical work. And it gives me something to do in those spare moments when patients don't turn up. I've been lucky – I've stayed in the same place all my career, but I have worked with people and an organisation who have enabled me run with my own interests.

Then there's medico-legal work. I originally got involved in legal cases for my patients and recall appearing in the High Court over 25 years ago. Then further requests came in and I built up a practice as an expert witness. I like the competitive challenge of having to carry out an assessment that is going to be challenged by the other side either in or out of court. Being challenged and cross-examined sharpens skills – you have to get it right. I've been involved in some fascinating medico-legal cases, one of which involved going to South Africa and assessing a group of Zulus who had been poisoned whilst working in a mercury-processing plant. For a very short while I was one of the world's leading experts on neurotoxic poisoning and brain damage!

As I've become older, I've progressively started feeling more comfortable talking to an audience. I now really enjoy it, but it does require practice. Like writing a book, or painting a picture, it's about transmitting ideas in stories and images. I know a colleague who initially felt nervous speaking in public and avoided it. She became a highly rated clinical lead and manager, but was hamstrung by her anxiety that had developed into phobic proportions. 'Face your fear and it will disappear!'

Reflections and advice 

Try and keep as much variety and contrast in your job as possible. As a basic-grade psychologist I started working on a psychiatric rehab ward, the local adolescent unit, and servicing a local psychiatric inpatient and outpatient service, then worked briefly on a forensic intensive care unit and in an older adults service. For the vast majority of my career I have always worked in a variety of settings in a mixture of adult mental health and neuropsychology. To stay fresh mix up group work with individual work, assessment work with therapy, clinical work with management and organisational politics, teaching with research. Variety helps avoid burnout. From my observation, colleagues who solely engage in psychological therapy experience burnout and retire more quickly.

The first academic paper I ever published was 'An evaluation of anxiety management groups in routine clinical practice', in 1987. The result of the small study was that patients viewed the best part of the therapy as 'meeting other people in the same boat'. Since then I have run many different groups: assertiveness training groups, social skills groups, memory training groups, post head injury support groups, and most recently groups for people who have just been recently diagnosed with ASD. All these groups are a mixture of structure, disseminating ideas and coping strategies and people telling their stories. As my career has progressed, I have come to realise that individual psychological therapies have their limitations and that we all have differently wired-up brains and face different challenges – I am slightly dyslexic, for example. I rather like the idea of a psychological therapist being an 'expert companion'; certainly, this model helps patients on their long journey post head injury or post diagnosis of ASD.

Being part of a team requires effort. I have had a foot in many teams in the past, but when you are a part-time team member, my advice would be always make a point of going to Christmas parties and leaving dos – let people see you for who you are. I've been lucky enough to always have my own office, somewhere to retreat to and have time and space to think and write. This is going to change within the next year: soon I will be in an open-plan office with everybody else. I hope I've got plenty of floor space to spread my mess! 

I can also warn those starting out that as we get older our memory efficiency, word finding and speed of information processing all deteriorate – whether we have dementia or not. Yet one skill that improves with age is 'pattern recognition' or for want of a better word 'wisdom'. As a clinician, I can 'see the wood for the trees', a picture emerging in an assessment, much quicker than I could 37 years ago. I don't have to ask as many questions or give as many psychometric tests, I can see the patterns, it all makes sense more quickly. What's more I am not aware that I am doing it. It has become an 'automatic pilot' type skill, no longer requiring conscious thought; a programme passed to the right hemisphere for automatic transmission.

And that kind of skill has been vital. Every day of my career has been full of challenges and problems to solve. I can honestly say I have always looked forward to coming into work. My advice to new psychologist is: Don't expect to cure every patient or to get everything on your to-do list done – keep expectations realistic! Keep as much variety in your job as possible. Enjoy the privilege of being paid to help people, working with caring, intelligent people, and being constantly exposed to interesting ideas.

Key publications

Powell, T.J. (1987). Anxiety management groups in routine clinical practice. Behavioural Psychotherapy, 15(2), 181–188.

Powell, T.J. (1994). Head injury: A practical guide. Bicester: Winslow Press and Headway.

Powell, T.J. (2000). Chronic neurobehavioural effects of mercury poisoning on a group of Zulu chemical workers. Brain Injury, 14(9), 797–814.

Powell, T.J. (2007). The brain injury workbook (2nd edn). Bicester: Speechmark Press.

Powell, T.J. (2009). The mental health handbook (3rd edn). Bicester: Speechmark Press.

Powell, T.J. (2016). Recognising Asperger's syndrome: Adult diagnosis and after – a practical guide. Bicester: Speechmark Press.