‘We don’t pay enough attention to our own recovery from the emotions we help to hold’

Tell me about your background, and what spurred you to pursue a career in psychology.

There are interwoven layers of external and internal influences that span across countries and traditions to make up my personal 'background'. Even the question lands as a burden of responsibility to me. To which place and which culture shall I assign my identity to? For someone like me, any degree of public visibility comes with the need to represent views of my country of origin in a way that is respectful and acceptable. Not doing so would cost me the 'rooting' I rely on to survive. At the same time, by assigning too much importance to that, I risk out-casting myself as not British-enough, and not quite fitting the image of a Clinical Psychologist that I rely on for any future 'blossoming'.

But I still need to answer your question, of course! So here goes.

I was born in Hong Kong to Nepali parents at a British Army Camp. My childhood was spent moving between different countries including Hong Kong, Nepal, Brunei, and Singapore. As a seven-year-old school student in Brunei, I was teaching myself how to eat noodles with chopsticks because no other cutlery was available in the canteen. In the mornings for breakfast, I was learning how to eat with a knife and fork because my father insisted it was necessary to learn. Then in the evenings, I was clumsily and determinedly eating my rice and dahl with hands because that is how my mum, and almost every Nepali, ate. That's how I would illustrate a fusion of thinking, doing and being, that has now become me. 

When did you live in Nepal?

At the age of 10, I did a couple of years of boarding school there, probably my first and last proper exposure to life in Nepal. I didn't quite fit in there either. But not fitting in was my thing. I never wanted to fit in. I enjoyed standing out, irrespective of the challenges that came with it. Fitting in became a necessity only once I arrived in the UK as a 12-year-old. I have always understood this as a developmental need that I experienced because as I was coming up to becoming a teenager, but I think there was also something about the school environment in the UK that expected conforming at a level that I had not experienced in other countries. 

I was acutely aware that my social survival depended on quickly adapting to look and act like one of the English kids. Through constant and deliberate effort, I kept adjusting myself so that I did not differentiate in any way. Of course, I would have been different – my skin colour was different and I spoke with a dramatic American accent having learnt English mostly through American TV sitcoms. But as far as I was concerned, I had succeeded in my quest to fit in and be accepted. I think I even somehow managed to make my way to the most popular group in school, most of whom probably did not even know I was from Nepal. It has taken me years to un-do the suppression of my true self and un-cover a mixed identity that I could begin to feel proud of. It is a work in progress.   

So, how did all this lead to a career in Psychology? 

I am not wholly sure! I hadn't even heard of psychology as a subject, until I went to college. Mind you, I loved it. I guess previous experience of moving around and going through a methodical process of adaptation had instilled a curiosity for observing and understanding people and systems, which eventually drew me to a career in psychology.   

What made you interested in going down the clinical psychology route? 

Rather accidently, I must admit. If you are a south Asian reader, or know someone who is, what I am about to say next will probably not shock you. My father had decided – before I was even born – that I was to become a medical doctor. The problem was: I hated studying. Schools were too institutional and authoritative for my liking. I won't admit how old I was when I first bunked school to go to the cinema, because it will seem too outrageous!

Anyway, I did not want to study medicine. Unfortunately I did not have the courage to outrightly disappoint my dad, so I played along. Unsurprisingly – for me, at least – I did not get the grades for medicine, so went to University of Leicester to study a pretty much made-up subject called 'Medical Physiology', as another possible route into medicine. In my second year there, my personal tutor realised I did not have the enthusiasm for medicine and saw something in me that he thought would suit a career in Clinical or Forensic Psychology. After an insightful conversation with him, I rushed back to my room, typed Clinical Psychology into Google and immediately understood it was for me. I might even have read a BPS article! I wrote down a list of qualifications and experiences I needed on a piece of paper, which I believe I hung up on a wall of every bedroom I inhabited since that day. Five years later, I got on to training at the University of Surrey. 

It sounds simple, I know. That doesn't mean it wasn't effortful. Until that point in my life, I did not know what I wanted to do with my life. The figuring out part was the biggest obstacle for me, nothing else after that. 

If I remember correctly, what appealed to me the most about a career in Clinical Psychology was the diversity of expertise it offered. It seemed that it could be useful in any field and that excited me. It also promised to skill you with strategies to help people help themselves, or at least this is how I summarised it in my mind. I saw that as a highly sustainable approach to problem solving. Of course, it helped that it granted you a 'doctor' title, which was the only argument I needed to take back to my parents.

What has your experience of navigating a career within clinical psychology as a Nepali woman been like?

I think it can feel quite lonely and tiring being a minoritised person of colour in Clinical Psychology. At least, that has been my experience and observation. There is this internalised pressure to work relentlessly hard just to prove your worth here, let alone to step further up the career ladder. 

The other day I was speaking with a Clinical Psychologist in training – a young Indian man – about the burdensome responsibility he felt on training to 'represent' the views of all South Asian men. He said other trainees will often literally look at him to say something noteworthy when issues of diversity come up in discussions, and most of the time he is thinking 'I don't have a clue'. He feels he needs to justify his position as a minority Clinical Psychologist by being useful to the rest of his cohort. This is on top of pressure he already feels from his family to succeed in the world. It is so unfair!

Coming back to your question, I am not sure there has been or is much space and permission to navigate the two identities. The clinical psychology training I had between 2012 and 2015 did not prioritise teaching and thinking on diversity, certainly not as much as these days. My work experience since then hasn't adequately supported such a process either. Any personal reflections on the matter have been mostly private and emotionally costly. 

I don't think I know how to translate my Clinical Psychology skills – which are too cognitive and individualistic – to fit the mental health expression of Nepalese people. I also don't have the language skills or time – or energy, given the attached stigma – to convince Nepalese people that Clinical Psychology may possibly be of help to them. You see, I am a minority in both camps. I am one of only a handful of Nepalese Clinical Psychologists in the UK, as far as I am aware, and Clinical Psychology does not exist as a modality in Nepal; there are only counsellors, priests, and psychiatrists, I believe. Additionally, I feel a lack of true belonging, or welcome, in both spaces, which can be depressing sometimes. So it feels easier, at least for now, to keep the two identities separate.    

Thinking about it further, there was a time last year when my identity as a Nepali woman became so large and intense it started to push through to all the spaces I occupied, including work. My daughter and I had just returned from spending five weeks in Nepal with loved ones who literally and figuratively cared for us both. Once back, I noticed a strong sense of displacement and isolation as a first-generation ethnic minority living in the UK. I began wondering if it was an absence of community care and shared responsibility towards children and their mothers, or whether it was the unsustainable drive towards productivity and growth, that was contributing to my feelings of melancholy and tiredness. I wondered to what extent other first and second-generation colleagues were feeling this way too. I wondered whether my personal experience could guide my work in staff support in a multi-diverse NHS. But soon enough I lost the momentum because it was impossible to resist the strong environmental and cultural pull back to usual patterns of thinking and behaving – back to the British way of life. 

I am optimistic there will come another opportunity to return to those thoughts and do something meaningful with them. Let's see.

Tell me about your book Conceptualisation of Mental Health by Nepalese Youths Living in the UK.

The book is basically a write up of my doctoral research with the University of Surrey. At the time of doing my Clinical Psychology doctorate, I was living with my parents in Farnborough. Farnborough and its neighbouring town of Aldershot has one of the largest Nepalese populations in the country. I came to learn of a crisis of drug addiction and psychosis amongst Nepalese youths living in the area. The whole community seemed to be in a panic about it. I saw an opportunity to use my privileged position as a trainee Clinical Psychologist to study and therefore raise awareness of issues affecting the Nepalese-British community. It was my attempt to add to a thin body of research relating to mental health and ethnic minority groups.   

I used an Interpretative Phenomenological Analysis method so I could do an in-depth case-study of the six people I had recruited. I was interested in capturing their story and re-telling it through my Nepalese-British-psychologist-in-training lens. A fascinating theme to emerge was that a phenomenon called acculturation seemed to determine how Nepalese-British youths understood, expressed, and managed their dilemmas and experience of distress. Having a bi-cultural identity was a significant component of how they made sense of their problems, how they communicated about it, and how much they involved their parents' and community vs external services. Research participants spoke of a constant tension between two opposing but equally significant value systems. For example, children's unquestioning respect/submission to their parents' authority and decision-making clashed with highly attractive British values for individuality and freedom represented by peers, pop culture and even healthcare services. They did not know how to integrate or navigate the two clashing identities, or rather were not adequately supported to do so, thus putting them at risk for developing illness or inhibiting their recovery. 

People are welcome to access my doctoral paper of the same title for free via University of Surrey's website. 

You were previously the co-director of the Early Careers for The Association of Clinical Psychologists UK. Tell me about your time there.

It was almost five years ago, and ACP-UK were still rather young in their inception and influence. The Board of Directors at the time were so kind and encouraging. They were also ambitious – rightly so, as they had a lot of good work to do! Being surrounded by a group of more experienced and high achieving experts in Clinical Psychology overwhelmed me to the point of incapacity. I had major imposter syndrome – perhaps due to a lack of readiness or lack of self-belief – which got in the way of me using my voice as much as or as powerfully as I could have. 

I had a mostly supporting cast role, alongside James Randall, my co-director. We tried – in different but equally valuable ways – to represent the views of newly qualified psychologists. The most memorable input made was perhaps within the subject of equality and diversity in healthcare, and clinical psychology spaces, given my time at ACP-UK overlapped with Covid in which health inequities and structural racism became widely exposed. 

The question of how 'useful' I was to the organisation and to its early career members remains one that I revisit with a heart full of apprehension and mild dissatisfaction. Nonetheless it felt incredibly special and career-defining to be a part of this budding organisation.

Tell me about your current work?

I hold the position at Leicestershire Partnership Trust as lead for its post-incident pathway for staff support. It is a trust-wide role involving policy and service development, organisation-level training development plus delivery, and the provision of a coordinated staff support response for colleagues who experience high distress or trauma at work. It is a new role, that is continually being shaped by emerging need, gaps in support provision and on-going evaluation. 

More specifically, my role comprises some the following activities: facilitating psychological debriefs and reflective practice sessions to teams; providing supervision to colleagues in high impact roles; mental health triaging and forward signposting; training staff on debriefs, educating about work-place trauma and staff support available; chairing MDT meetings and consulting with service leads to identify gaps in access to staff support etc. Underlying all these tasks is the consistent valuing of colleagues and the relationships with and between them. I find that the relational and systemic nature of the role, as well as the variety it offers fits my style so much. It is truly energising.  

I work closely with and under the supervision of Jon Crossley, who is LPT's Associate Director for Psychological Professions. He brings the influence to match my motivations, and together we try to advocate for effective staff support provision as the foundational basis for effective patient care provision. Usually, no one disputes that a healthy and happy workforce is essential. The challenge is having to constantly provide quantifiable justifications so that there is a secure flow of investment into it. It goes back to my point earlier about always having to prove your worth. I am personally well-versed in it, but it isn't an ideal way to set up or run services. Still, I believe staff support is a fantastic new specialism for Clinical Psychology, and I am very glad to have fallen into it.    

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

I will mention a couple of books here. Firstly, the book published by ACP-UK, edited by Harriet Conniff, and containing contributions from various healthcare practitioners: Psychological staff support in healthcare: Thinking and Practice. The vast collection of creative thinking and good practice presented within the book has played a kind of mentoring role for me, both inspiring and reassuring. It has been a grounding and guiding force to help navigate the uncertain terrain of staff support in post-covid NHS.

The chapter that shaped my practice the most was the one on debriefs by Sadie Unsworth-Thomas and team. In fact, a group us of at LPT, alongside our sister trust at Northamptonshire, received training from Sadie on how to run Post Event Team Reflections; a debrief model that we have since largely adopted in my trust. I think that Sadie's work has made debriefs a lot less daunting/a lot more accessible to psychologists. Also, personally, I am such a fan of her style. She expresses her expertise with such humility and warmth that you are left awe-struck. 

Another source of inspiration was The Myth of Normal by Gabor Mate. This was an epic book, with outrageous revelations chapter after chapter, but a few points have really stuck with me and which I regularly reference in conversations with colleagues. First, the accumulative and negative impact on our physiology of feelings not voiced and needs left unmet (e.g., through self-withdrawal or denial by others). Second, the conflict within us between a desire for attachment (belonging) and a second equal desire for authenticity (being oneself). This thinking can apply beautifully in terms of how we feel and behave at work. If our sense of belonging and shared purpose is threatened, when we don't feel looked after by others at work – in a psychological or even a physical sense – then our ability to think critically and autonomously, as well as our ability to take care of others, can be hindered, leading to all sorts of problems at an individual and collective level. 

Thirdly, to be effective in a healing role you must constantly prioritise your own healing. When we work so intimately with other humans, we absorb their trauma. If we don't have an effective outlet for it, we keep on adding trauma on top of trauma, and we risk becoming unwell ourselves. Of course, I am simplifying pages of content into a couple of sentences, and in the process possibly losing all the necessary details and nuances. Still, it makes me wonder whether as psychologists we pay enough attention to our own recovery from the impact of our work, from the stories we hear, and the emotions we help to hold. Not enough, in my opinion. It is interesting that there is no requirement in Clinical Psychology training to undergo personal therapy as a preparatory measure. Yes, I understand we are meant to be 'scientist-practitioners' but surely this is ignorant of the actual nature of our day-to-day work and its impact on our mind, body, and spirit. 

What advice would you give to aspiring or early career psychologists from a minoritised background on either navigating or pursuing a career in psychology?

I think we ought to stop burdening aspiring and early career psychologists with the responsibility to self-sacrifice and fit themselves neatly into the profession; instead, we need to demand that training programs and psychology departments adapt themselves to accommodate, nurture and celebrate psychologists from minoritised and marginalised backgrounds. This is not an individual issue; it is an institutional issue. 

However, if I must give advice to individuals, I would say the following:

Take Clinical Psychology off the pedestal. There is no need to worship it. Doing so will create a power imbalance that will take years to correct, if at all. You may have a good idea of why you want to become a Clinical Psychologist and how you plan to get there. Now, pay some attention, to considering what difference you could bring to Clinical Psychology. Because it absolutely needs that difference you could offer.