‘The continuity of my role has given me the chance to grow’

As we 'collect' our final person of the day from the virtual waiting room to triage for our autism assessment service, I barely need to ask our initial questions before we are swept along by their story. Their reasons for believing this diagnosis is right for them are interspersed with talk of 'special interests' that appear characteristic of autism. I'm intrigued as we're taken on a range of meandering paths, and instantly reminded of why I love this clinic and working with those we see. This person is totally different to the other three we've seen that day, though all displayed some traits akin to autism. Despite the wide variety in presentations, there are undoubtedly some uniting positive themes – passion, honesty, and attention to detail.

Seeing people by video due to the pandemic presented a whole host of new challenges for our small service but, after a period of adapting, these changes became just the latest of many made to our service over the years. Having now reached the milestone of a decade working as an Assistant and Senior Assistant Psychologist within this specialist team, I've come to realise that the longevity of my experience is somewhat unique. When our service was recently integrated into the NHS, I was both surprised and pleased to learn I'd been allocated Agenda for Change band 6 in the banding process. I felt incredibly proud that my many years of experience working in the service, along with the skills I've gained along the way, had been formally recognised and rewarded. This did make me wonder, though, why this isn't more widely available to others. Are we missing out on part of a more diverse career pathway for those working in psychology?

A significant role

I have been on a considerable journey in my role over the last 10 years, from the starting point of being in a very small team where there hadn't previously been an Assistant Psychologist. Having developed my knowledge and skills, I moved on from predominantly clinical administration and scoring of psychological questionnaires, to taking a significant role within the team's clinical work, under the supervision of qualified Clinical Psychologists. I'm trained to take comprehensive developmental histories, work with families, and conduct in-depth interviews, in addition to conducting assessments of intellectual functioning and social cognition, under supervision. I'm proficient at writing complex psychological reports (though still encounter some challenges!). I am also able to develop psychological formulations, a skill helped by a previous role I had in the Improving Access to Psychological Therapies (IAPT) service, which provided a solid foundation in mental health, for constructing formulations and considering differential diagnoses. In addition, I undertake service reporting, help inform wider service developments, and help with the induction and supervision of other Assistant Psychologists in the team.

I have grown along with our service. I now have a clear understanding and experience of every aspect from administrative processes to the clinical work, which gives a unique insight. I know my team really value that. They are quick to comment on my ability to keep track of different aspects and processes, as well as helping to provide assessments and forming a secure foundation for the service to operate from overall. I believe the continuity of my role has given me the chance to grow and develop both personally and professionally, in tandem with the various changes that have been implemented over the years. There are always fresh challenges to face.

Whilst I have been fortunate enough to move up the bands in recognition of my length of service and the specialist knowledge and skills I bring to the team, doing so appears to be somewhat of a rarity without wider comprehensive training. We see so many short-term Assistant Psychologist or Honorary Assistant Psychologist posts advertised. Both clearly have great value and are needed, but it is disappointing to see that short-term roles seem to be the norm. This inevitably creates a lack of security for those working in this field. Moving beyond a band 5 as an Assistant Psychologist is not suitable for everyone, but when an individual is able to demonstrate sufficient competency, along with significant experience and expertise within their particular discipline, it would help to retain staff who have that depth of service-specific knowledge. It would provide a level of progression that means Assistant Psychologists don't have to always be thinking about 'what next' for them in a short-term post. Talking of which…

What next?

I believe that Senior Assistant Psychologist roles in some services could offer a welcome alternative to the much aspired for Clinical Psychology Doctorate. I personally haven't taken this route yet – I have a young family, and live a considerable distance from the nearest university. I've accepted this is not something I'm able to do in the immediate future… that wasn't easy, but since being awarded this higher-level banding, I feel some of the pressure to move on has been taken away.

I feel that the progression to include band 6 Senior Assistant Psychologist posts as a career route would be rather timely, sitting alongside a shift that has started to take place in Clinical Psychology over recent years [https://thepsychologist.bps.org.uk/widening-psychological-workforce] towards a wider and more inclusive workforce. Roles such as Clinical Associate Psychologists (CAPs), first piloted here in Cornwall, provide much needed stepping-stones for those who, like me, cannot or do not wish to progress to full Clinical Psychology training. In many ways, I see my role as the equivalent of a CAP, though based on significant clinical experience and proven skills rather than an emphasis on academia.

Traditionally, lots of Assistant Psychologists have felt pressure to gain as much experience from several different clinical settings to support applications for further training, and have shown incredible drive in doing so. My experience has involved developing a depth of knowledge and skills within a particular core clinical speciality. I don't see this as limiting. I hope that if I do decide to apply for the Clinical Doctorate, it may even stand me in good stead, as it will be different to most experience that others bring to their applications. At this time, though, I don't feel the Doctorate is an essential pathway for me. That is what I find so exciting about the 'wider workforce' changes. It's great to have specified pathways such as the Doctorate, but alongside a shift towards less rigidly defined routes too. Accessible options for a long and fulfilling psychology career for more people will in turn allow for a more empowered and diverse psychology workforce.

There are clearly drawbacks of not having further official training. For example, if I were to switch roles, I don't know whether I would be able to do so at the same band and this may obviously depend on the role itself. Additionally, despite my increased independence, I can only practice under the supervision of a Clinical Psychologist and whilst registered with the British Psychological Society as a graduate member, I cannot for instance register with the Health and Care Professions Council. The great benefit to this, though, is that I continue to receive regular valuable supervision as part of a close-knit team.

Shape and develop your role

So what's my take-home message for aspiring psychologists? I really see the value of long-term roles and would encourage others not to rush between positions. If you are able to secure an Assistant Psychologist role – a considerable challenge itself! – push yourself to see how you can shape and develop it, and yourself as an individual. This is an exciting time for those working in this area. Our service users will reap the benefits, if these changes lead to greater diversity, longer term posts being available and higher staff retention in specialist roles for individuals to progress.

And what about my message to services? Consider the skill set of those who may be working at a higher level, have shown commitment, and significantly contributed to their service. They deserve to be recognised and valued. Obviously, Clinical Psychologists are still in high demand but let us not underestimate or undervalue the workforce that we already have. Assistant Psychologists are often motivated, driven and passionate. Giving them the chance to accomplish and demonstrate skills in the workplace is just as valid as requiring them to prove worth within further educational training.

- Lucy Freemantle is a Senior Assistant Psychologist working in Cornwall Partnership NHS Foundation Trust