When personal and professional identity meet

I am a bisexual cisgender woman, born and raised in Blackpool, Lancashire – one of the most deprived areas in England. The town's residents are disproportionately affected by poor physical and mental health (Office for Health Improvement & Disparities, 2023). I acknowledge my privileges in a variety of areas, including being White, able-bodied, and able to access higher-education. And yet I have a history of mental health difficulties myself, initially seeking support at the age of 14 from a children's mental health service. Throughout my childhood and adolescence, I experienced intersectional discrimination related to my social status, gender identity, and sexuality, including bullying, sexual harassment, and assault. 

In hindsight, my perception of healthcare professionals came into conflict with my self-perception at a young age. I was not exposed to overtly working-class or queer people in healthcare settings growing up, and no one within my community was employed in 'senior' healthcare roles. As I was the first person in my family to go to university, my family had minimal knowledge about higher-education, nor psychology as a discipline. I felt disheartened at times by their lack of insight, as I was unable to hold in-depth conversations with them about my course and future aspirations. It also led me to place a substantial amount of pressure on myself to perform well, with them often reinforcing my potential to exceed the career boundaries by which they were constrained and, in doing so, my ability to make them proud.

I completed my Bachelor's degree at the University of York, after which I wanted to complete a Master's degree like many others on my course. However, I needed to move back home and work until I saved up enough to self-fund this. This was when I first began my mission to obtain an AP role, but I quickly realised I was a small fish in a big pond of candidates, and my applications were limited as I could not afford to learn how to drive. 

After several unsuccessful attempts, I looked to gain experience by obtaining a support worker role in sheltered accommodation for ex-offenders with mental health needs. Soon after, the Covid-19 pandemic hit. It was a difficult time for care staff to navigate psychologically. I struggled through this period and saved every penny I could, hoping that moving to a city and pursuing postgraduate study would improve my chances of becoming an AP.

Losing my motivation

I later moved to Manchester to complete a Master's degree in clinical and health psychology, while working part-time in a care home for people with neurological conditions. City living is difficult for people on minimum or low wages, with people in Manchester now spending more of their salary on bills than anywhere else in the UK. To manage, I took up full-time hours in my care role after completing my Master's, often working back-to-back 12-hour shifts and 60-hour weeks. 

Most days I would come home feeling both physically and emotionally drained, but this reached an almost unbearable level as Covid-19 continued to ebb and flow. I fought against burnout and pushed myself to write personal statements for AP applications in the early hours of the night, scared that they would be closed as quickly as they were advertised. Following interviews, I received feedback that despite performing well, they appointed candidates who already had AP experience. I was trapped in the impossible cycle of 'needing experience to get experience'.

Over time, working excessively and feeling continuously rejected led me to lose all motivation to keep striving. Just as I was ready to stop endlessly searching job sites, an AP role funded by Health Education England was advertised, into which I was recruited through an exploration of links between my values and clinical competencies. The post was only open to people without prior AP experience and applicants were encouraged to reflect on psychological knowledge and skills that they acquired through lived experience. This initiative seeks to foster a more diverse workforce by eliminating barriers to recruitment which, in turn, benefits the field by developing a workforce that is representative of the population it serves.

Alongside initiatives to address biases within recruitment, it's also important to explore individual narratives of how societal disadvantage influences individual's wellbeing following appointment. Contrary to my expectations, my first months working as an AP were challenging in a variety of different ways. Due to AP roles being difficult to obtain and seen as 'gold standard' experience for doctorate programmes, we risk putting pressure on ourselves to perform well and not 'disappoint' those in fully qualified roles. My experience was also complicated by what I now understand to be internalised stigma pertaining to my working-class and bisexual identities.

My fear of not 'fitting in'

Within my first few weeks as an AP, I developed an unshakable feeling that due to my working-class identity, my colleagues may look at me as being 'unintelligent', despite no evidence of classist bias during our interactions. In an attempt to counteract this, I put pressure on myself to carry out my role perfectly, setting myself unrealistic and unattainable standards. I was reassured that I had lots of time to develop my knowledge through reading, shadowing others in the department, and practising new skills within peer and clinical supervision. However, this didn't alleviate my worries; I felt an ongoing need to prove my 'worth'. I chastised myself after making minor mistakes, with a toxic inner voice telling me that I was not 'good enough' at every opportunity it could.

The sound of my own voice fuelled my imposter syndrome further. My broad Northern accent stood out within certain areas of my work, particularly in multidisciplinary team meetings with others in more senior positions. During interactions with service users, I worried that if I spoke normally, they would not look at me as a professional, and dismiss my practice. When conversing with clinicians, I found myself trying to compensate for this by unnecessarily using lots of jargon. 

I became hypervigilant of differences between myself and my colleagues, reinforcing my feelings of not 'fitting in'. I sought support from my peers and previous supervisor who, despite their best efforts, were unable to facilitate my self-esteem through providing reassurance. I tried to invalidate my feelings by telling myself that I should feel grateful to be working as an AP, but challenging myself this way only led me to feel guiltier.

Through working as an AP, I have also come to realise that heteronormativity continues to prevail within healthcare settings. On multiple occasions, I have been asked by colleagues if I have a 'boyfriend'; a microaggression in which LGBTQIA+ people either feel forced to disclose their sexuality or acquiesce with heteronormative assumptions. Some of my colleagues also seem to favour monosexual identities; 'he said he's bi, but he'll eventually come out as gay'. Taken together with thoughts related to my working-class identity, these homo/biphobic interactions led me to isolate myself further. Research has highlighted that bisexual people may experience worse health outcomes than both homosexual and heterosexual people, including higher rates of mental health difficulties and poorer outcomes from psychological interventions.

My steps moving forward

For the sake of both my mental wellbeing and future success, I have taken a lot of time to reflect on why I became ashamed of my identity upon commencement of my first AP role. This has involved identifying unhelpful thought processes, reflecting on their origins, and attempting to form alternative perspectives. 

In doing this, I came across the concept of internalised stigma, whereby discriminatory beliefs and behaviours can infiltrate our sense of self. Despite having colleagues that treated me as an equal, prior experiences of discrimination related to my working-class and bisexual identities led me to believe that I was not. It has also been suggested that internalised classism is more likely to manifest when a person's socioeconomic status improves from that of their childhood. Learning this felt particularly pertinent as my AP role was the first that required higher education, the first in which I was paid more than minimum wage, and the first in which I had colleagues from middle-class backgrounds. 

Given my mental health history, I tried attributing my thoughts and feelings to more generalised experiences of anxiety, normalising them in the context of starting a new role and hoping that they would resolve as long as I continued to practice self-care. However, addressing my difficulties has required more in-depth self-formulation; separating my internal self from external disadvantages, and reframing the effects of these external disadvantages as being advantageous to my clinical practice. My lived experiences of disadvantage mean that I can relate to a wider-range of service users with greater ease and empathy. This allows me to form strong therapeutic alliances with service users, which is crucial to their achievement of positive psychological outcomes. They have also shaped my core values, such that working to address health disparities is something that I have and will continue to strive for throughout my career in Clinical Psychology.

Supervision has also been pivotal to my change in perspective. I've been supervised by two Clinical Psychologists who have supported me to grow from these challenging experiences. One also comes from a working-class background, meaning that we've been able to reflect on shared experiences and broader issues related to classism within Clinical Psychology. They signposted me to ClassClinPsych; a 'collective exploring the experience and impact of class on the career journey through Psychology in the UK' (ClassClinPsych, 2021). During my first ClassClinPsych webinar in November 2023, I heard about the journeys of two working-class Clinical Psychologists, and learnt that I was not the only person who had contended with feelings of non-belonging. Despite the additional barriers some of us face, becoming a Clinical Psychologist no longer seems impossible when we have these types of visibility.

Countering feelings of non-belonging

For those of you reading this in supervisory roles, I strongly encourage you to develop an awareness of internalised stigma and how this may affect the wellbeing of APs or Trainee Clinical Psychologists from disadvantaged backgrounds. Additionally, please be mindful of how criteria for AP recruitment may either explicitly or implicitly discriminate against those from disadvantaged backgrounds, such as requirement for a full driving license. When supervising individuals with no prior AP experience, it may be beneficial to offer longer supervision sessions during their first few months in the role, to allow for more in-depth reflections on their wellbeing, and additional time to scaffold clinical knowledge and skills. It has also been helpful for me to have supervisors who are both physically present and approachable outside of our allocated supervision slots, providing informal supervision and support during an important period of transition and development.

Finally, I strongly encourage anyone who has been affected by societal disadvantage to also voice and share your reflections on how your intersectionality has influenced your wellbeing within work, irrespective of your role within Clinical Psychology. By doing so, we can counteract feelings of non-belonging amongst people from diverse backgrounds, and empower them to flourish in the profession through the provision of their unique insights, talents, and skills.