‘The hospital has the feel of a massive living thing’

Tell me a bit about your background and what inspired you to pursue a career in psychology.

Probably early on, lots of focus on academic work and achievement. I went to a grammar school in Skipton, North Yorkshire. I can't say I really had any sense of thinking for myself back then, it was more of an exam factory – all about 'league tables'. I remember finding school stressful and competitive.

In my family, my parents divorced when I was age 8, and I was close to my grandparents. I can't say I was inspired to go into Psychology. I liked art, and wanted to pursue that. But I remember conversations like 'what career would there be in that? I liked geography too – maybe in physical geography there's something a bit 'psychological' about diversity in rocks and rock formation, the flow of rivers, the process within glaciers; and in human geography is a lot about relationships.

By the time I was doing my UCAS form, my sister was studying Psychology, and it sounded interesting. It was the mid-1990s, Cracker was on the TV, and I thought he was quite cool. I went on to do psychology in Edinburgh, I liked how it was a four-year degree, and in the first two years you got to do other subjects like philosophy, artificial intelligence, and politics.

After my degree I joined a graduate scheme with a multinational company, and I knew on my first day I hated it. I missed university, and went back for a PhD! I like the feel of a university. I probably like the feel of big institutions.

Why Clinical Psychology?

My PhD was very academic and quantitative. It involved interviewing people who'd had traffic accidents, and I was looking at how people remembered what happened to them, and how this related to head injury, the development of PTSD, and sleep difficulties.

I met with people as soon as possible after the accident, then after six weeks and after three months. There were lots of forms for people to fill in, numbers and analysis, but the bit I liked the best was chatting to people with a cuppa before we did the 'research'. It was like this initial informal conversation had far richer 'data' in it than the numbers!

Coming into the third year of my PhD, I applied for DClinPsy … I said to myself I'd apply and see what happens. Plan B was to do some kind of post doc. To be honest, I liked studying, and the idea of being able to carry on studying while being paid is pretty appealing. I think I was a very slow starter and I still didn't know what I wanted to do, and training offered another very scaffolded three years to figure it out.

You work as a Consultant Clinical Psychologist with people living with long-term medical conditions; tell me about this and your role.

Well, that sounds like a grand title doesn't it, but in reality, it's all still about the slow taking care of relationships and trying to be in the right place when opportunities come up. I love our psychology team, and trying to understand what everyone needs for their work to be fulfilling.

Our work is to support people with long-term medical conditions like diabetes, asthma, lung disease, gastro problems, HIV. It's very much about being alongside people and often the work is as much about supporting people to navigate our frustrating systems, as it is about living with the health condition itself. There's a lot about loss and grief, and appreciation for what matters in life. In the team a lot of us have young kids and between us we have some health conditions too so it feels like there's a lot less othering than I've experienced in other settings.

I tend to see our role as 'facilitators' within a complex system. I also think we can engage with social media in this way too – trying to support dialogue, curiosity, and understanding.

What does a typical day at work look like for you?

Southmead is a new build, very impressive hospital. If you imagine there are a couple of Costas on site and a shop. People say it feels like an airport – there are different 'gates' for patients to check in at. No big Toblerones though!

I sometimes think the most important meetings with colleagues happen in the canteen – it's a good place to bump into people informally.

As a team we have outpatient clinics every day, which is scheduled and more like typical 'therapy' with people, I guess. We also see inpatients which is responding to need usually within a day or two. There's a big emphasis on flow in the hospital and we have to consider how can psychology input help a person who might be struggling to engage with their medical care. We have to have good relationships with colleagues from loads of teams.

Since the pandemic we all have a bit of a role in 'staff wellbeing', and we get invited in to all sorts of interesting situations. I'm generally keen to know that my psychology team is ok. Our admin and manager colleagues are key to looking after the operational side to free us up for the clinical work and to have space to think. I love having trainees join the team on placement; the energy and questions they bring.

What do you most enjoy about your role?

I love working in a hospital, it does have the feel of a massive living thing. I love the team working and hearing a range of views. My wish is that the team is thoughtful and ethical and so we share a lot of views, rather than relying on criteria. I like the variety of work, the different vibe you get with the different medical specialties – each has its own culture. What strikes me is how valued we are as psychologists in the hospital. It's so clearly a medical model in acute care, that it's obvious where we can complement the work of the medics with our psychological thinking.

The challenge is how to make a small resource go as far as possible. I like keeping it simple, and there's something about the acute hospital environment that lends itself to needing to get very succinct – everything is like an elevator pitch, everyone is rushing around, and you have to think pragmatically in terms of 'if I had five minutes to speak with a bunch of junior doctors what can I usefully say in that time?' And, over the years I've noticed how the things that are so obvious to us, can be seen as a bit radical to 'non psychology' colleagues – like the importance of listening, multiple perspectives, connection.

What do you find most challenging?

It's difficult seeing how chronically stretched everything is. It can be an unthinking environment, with a heavy emphasis on productivity. I also struggle to see how much hospital care costs and how it's a 'vote winner' to talk about investing in hospitals, compared to underinvestment in prevention. e.g., I see the amazing expertise and tech there is in medicine, but we seem to do far less about social and environmental factors. I often wonder, as a team of psychologists how could we be re-positioned somewhere else in the 'system' to make more difference?

Also, look at the big drivers in healthcare – e.g., a shift towards 'compassionate leadership', away from something far more command and control. If we think of empathy, an emphasis on relationships, listening, support – it's all stuff we're good at. Other big areas in healthcare like various forms of 'integration' across services, supported self-management in long-term health conditions, complex comorbidities, 'high impact users', inequities, need for honest conversations, complaints, power in healthcare etc etc – all of these things are profoundly psychological in nature. We have so much to offer – where are we? There's a challenge! Professionally, are we up for this?

Can you share a piece of work or research that has really changed or influenced your practice?

I love the work of Alan Cribb, he is a philosopher. His paper with Vikki Entwistle 'Enabling people to live well' is my go-to paper. I love it. He also writes about tensions in healthcare, and what's really going on in 'collaborative working', shared decision making etc. I really recommend his work, to get underneath the 'same old' narratives to something deeper.

What advice would you to give to anyone interested in pursuing a career in clinical psychology?

I'd say don't get so invested in it, have a Plan B. Take the pressure off yourself. What I love to see in people interested in pursuing a psychology career is curiosity and critical thinking – lots of 'why' questions, noticing how things are and questioning it.

I also think a big thing is a willingness to be critical of psychology itself. I have seen many times people get to that point of being so fed up with the doctoral application process, and it seems that as people start to express frustrations and start to become critical about psychology, people start finding their own voices and this is a better place to be. I think there can be a preciousness in psychology, and I appreciate people who can just talk normally.

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