Degree(s?), experience, skills and training… but still ‘unqualified’?

We have both worked as Assistant Psychologists (AP) in a number of different settings. Something that has come up for both of us is being referred to as the 'unqualified' members of the team. This has left us feeling replaceable, voiceless and unheard, judged, fearful of showing vulnerability and as though we are failing. 

We are not assuming we are qualified applied psychologists. However, we consider ourselves qualified to be an AP. We have undergraduate degrees and sometimes are qualified to masters' level in psychology, with often multiple layers of experience and knowledge. It's hard to find that middle ground as an assistant psychologist. What we have noticed is, you can feel skilled, useful, and valuable but also that sometimes too much responsibility is being put on your shoulders. Alternatively you may feel contained, safe and well supervised but at the same time disempowered and infantilised. This can leave you with a sense of being 'stuck' until you get on to training.  

Never enough?

There are times we have noticed a sense of urgency to get on to training. Time not spent on training can be perceived as a waste, a failure in some way. Of course, rationally we know that's not true. All the time spent gaining experience is valuable, and a time we will almost certainly look back on and miss. However there's something about the process that leaves us with a sense that being an assistant psychologist isn't 'enough'. 

There are many different unhelpful cycles for those working within assistant psychologist roles and trying to get on to training. These cycles are most certainly being reinforced and triggered by many different elements of journeys within the profession, and by the systems currently in place. We have explored how we understand the term 'unqualified' feeds our own unhelpful perceptions in regards to getting on to training courses and being an AP. 

We have been left with thoughts such as; 'I need to get on to training', 'I am not succeeding if I am in a role that is not qualified', and 'the only way to be working within clinical psychology is to be a clinical psychologist'. This can prompt pressure, fear, shame, guilt, in turn feeding into behaviours such as taking on extra work or projects, dedicating a lot of time to committees and groups outside of work, or considering further postgraduate education.

We both feel we have a perfectionistic, striving nature, which appears to be common amongst psychologists. In a study which explored burnout amongst counselling and clinical psychologists, Simpson et al. (2018) identified the two most common early maladaptive schemas amongst participants were unrelenting standards and self-sacrifice. When we explored what unrelenting standards were described as we found it sounded familiar. We wonder if others will too? 

In their book Reinventing your life, Jeffery Young and Janet Klosko note the following about the experience of unrelenting standards:

'The primary feeling is pressure, you struggle to relax and enjoy life... You are always pushing, pushing, pushing to get ahead… Other people think you have achieved a lot but you take your achievements for granted. They are only what you have expected of yourself. ..You believe in the possibility of success, that if you keep striving you actually achieve that wonderful state of perfection … You imagine an end to the road when you can finally relax and enjoy life...You fantasise about some future time where you will be released but you would just find something else, some other relentless standard to meet. This is how your life trap reinforces itself. At your core you are not comfortable unless you are striving.'

We need to be kinder…

Clearly, we need to learn how to relax. We need to remind ourselves that getting on to training isn't the end goal, because we will find another one. We are already working in clinical psychology regardless of our role. But this does also point to some things that as a profession we may need to consider.  

Supposing there are many psychologists who may relate to the unrelenting standards schema. Is this life trap fed by qualities of the profession we are in? There is much within the system that is outside our control. However, the language we use isn't. Doing what we can to ensure all those within teams feel useful, valuable and most importantly, enough… is powerful and necessary. 

We can also apply what we know from psychology to our journey. Paul Gilbert's evolutionary model, outlined in his 2009 book The Compassionate Mind, resonates with us. This model explains distress as a result of an imbalance between three systems; drive, threat and soothe. Our drive system is the motivating system, associated with feelings of wanting, perusing, achieving, progressing and feeling focussed. These feelings appear so entangled with thoughts such as 'AP role is not enough', 'need to do more, be more to get further'. That's the pressure we feel from those early moments when we decided to pursue a career as an applied psychologist. Our threat system is associated with threat detection and protection and comes with emotions such as anxiety and anger. This is strongly interacting with our drive system, for those who may identify with some of the qualities of unrelenting standards: the threat is not getting to the goal, because that would be not achieving what we have set out to achieve. With the process of being an AP, applying for clinical training, this threat is very prevalent. It can be very difficult at times to be assured that things will work and that our time will come. Especially in a system that has flaws, people slip through the net and some people don't even have the opportunity to get in the net.

On such a difficult journey, which calls upon your drive and threat systems so regularly, we need colleagues, supervisors and employers to help us develop a 'soothing system' which allows feelings of comfort and security.

We are adults...

In our reflections, we discussed that the term 'unqualified' exacerbates and feeds into the perception of the 'unqualified' being the child and the 'qualified' being the adult. Tearle, Haith and Townsend (2019) discussed the idea that AP's can be seen as children, and that people assume a linear relationship between age and ability. There's also the issue that our service is mainly made up of female assistants in their twenties… perhaps the parent-child dynamic would be less common if teams were more diverse.

This potential for parent-child relationships in supervision might be promoted more in services that use the term 'unqualified', feeding the idea that supervisees need protecting. We understand that in services where AP's are at a higher risk e.g. forensics, these feelings of protection and containment are important. But there needs to be a balance to ensure AP's do not feel like children, and that they do feel valued. Using the terms of Eric Berne's Transactional analysis, we expect an adult-to-adult interaction but our child ego state can be activated if we feel criticised and/or patronised. 

Call for change

We were pleased to see a call for members to join a working group to update the employment of assistant psychologists in The Psychologist several months ago. We must seek to ensure that Assistant Psychologists are a valued and useful part of the profession. A recent study found that 25% of AP's surveyed felt they were working outside of BPS guidelines (Snell & Ramsden, 2020), so further regulation and guidance is necessary. 

In a letter to The Psychologist in 2012, Sofia Janjua wrote 'we are happy to be here and we are grateful. We still want a decent standard of living. We are not disillusioned millennials who need to put down our avocado toast. We work hard, we are experienced, we are driven and we are worth so much more than what is being offered.' This point feels just as relevant 8 years later. Systemic change is key to the safety and sustainability of the junior members of our profession.

We hope that by sharing our reflections we prompt supervisors, line managers and mentors to continue this conversation and help to empower assistant psychologists. For fellow pre-training colleagues, we hope there is something in what we have shared that resonates with you. The conversation must continue, and we must always be a part of it, we are the future of this profession!

-       Katie Voss [email protected]

-       Alice McNamara [email protected]

References 

Berne, E. (2016). Transactional analysis in psychotherapy: A systematic individual and social psychiatry. Pickle Partners Publishing.

Gilbert, P. (2009). The compassionate mind. Robinson.

Janjua, S. (2012). Letter: Inclusivity in psychology hopefuls, The Psychologist, BPS

Simpson, S., Simionato, G., Smout, M., van Vreeswijk, M. F., Hayes, C., Sougleris, C. & Reid, C. (2019). Burnout amongst clinical and counselling psychologist: The role of early maladaptive schemas and coping modes as vulnerability factors. Clinical Psychology & Psychotherapy, 26(1), 35-46.

Snell, T. & Ramsden, R. (2020). Guidelines Vs Reality: The Work Experiences of Assistant Psychologists and Honorary Assistant Psychologists in the UK. Association of Clinical Psychologists. 

Tearle, S., Hairth, C., Townsend, M. (2019). Beyond the title: What does it mean to be an assistant psychologist? Clinical Psychology Forum, BPS.

Young, J.E. & Klosko, J.S. (1994). Reinventing your life. PT Gramedia Pustaka Utama.