Working in Medical Psychology

Most people tend to think of psychology primarily in terms of mental health settings, but this overlooks the fact that physical health can significantly impact us mentally. In reflecting on our experiences, we'd like to encourage other people to perhaps consider a career in medical psychology.

As Assistant Psychologists (APs) working in Medical Psychology (known as Clinical Health Psychology in some acute NHS Trusts) we provide support to people of all ages across various clinical specialties throughout the Northeast of England and North Yorkshire. We work alongside other healthcare professionals and focus on helping people adjust to life with their medical difficulties, improve wellbeing, and support them in leading fulfilling lives. 

In psychology, the medical model considers how mental and emotional issues are related to biological causes and problems. It is not unusual for a person to experience a change in mood, lifestyle and relationships when managing a life-changing health condition. We offer evidence-based therapy such as Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) to help patients explore coping strategies to help improve mood and wellbeing.

Our work in Neuropsychology, Cancer, Major Trauma, and Paediatrics covers a broad region. However, socio-economic challenges faced by many of our patients, along with limited privacy on certain wards, can sometimes hinder access to psychological support. We see a wide range of patients of all ages and presentations meaning every day is different. As we reflected on our experiences, we thought about what would be most helpful to share with others interested in pursuing a career in psychology within a physical health setting.

Jess: Supporting patients through cancer and navigating major trauma

I work across two services, Cancer and Major Trauma, predominately with inpatients. Major Trauma in a physical health setting, is the emotional responses to a single 'physical trauma' event, not to be confused with language used in a mental health context. It is defined as an injury, or combination of injuries, which are life threatening or can be life changing because of long-term disability. Within both services, the main aim is to provide psychological support to those admitted to hospital with a cancer diagnosis, or who have been involved in a traumatic incident. 

My role involves the screening and assessment of a patient when they are referred to psychology, and then working with them to understand how they can be best supported to ensure that the most effective care can be provided. The support I provide is predominantly based around the principles of ACT and Compassion Focused Therapy (CFT), as well as normalisation, grounding and mindfulness techniques.

When reflecting on the patient population I work with, I am in awe of the resilience and motivation that patients show, even when they are undoubtedly going through an extremely difficult and emotive time. I am amazed to see the willingness that patients have when engaging with psychology and the support and interventions that are provided. The values a patient holds can become a huge talking point, and this allows them to have the time and space to think about what matters to them and how they want to live their lives.

As a result of this, I have seen many patients experience Post-Traumatic Growth (PTG). This is the idea of a positive psychological change that some individuals experience after a life crisis or traumatic event, which can sometimes shift the values patients have. The things that were once important such as money and power can become a distant memory, and patients want to live a life moving towards happiness, calmness and fun. This was never something I thought I would experience before I started working with these specific patient groups.

In supervision, as well as in my own time, I have had a lot of time to reflect on my clinical work and the patients I see. I have noticed that these patients have taught me some valuable lessons. I have become more appreciative of life, understanding that we are not guaranteed tomorrow. I have also been able to reflect on my own values and really understand what is important to me living a fulfilling life. I am grateful to work with the patients that I do and pleased that I can help and support them through a difficult time in their lives.

Emily: Assessing cognitive, emotional and behavioural function in Neuropsychology

I assist Clinical Neuropsychologists in evaluating patients with presenting cognitive, behavioural and emotional symptoms caused by various neurological conditions. I predominantly work with outpatients but occasionally assess inpatients from our neurosurgery wards.

I have the unique perspective of working across all our services within the team; our general neuropsychology service for patients with suspected or known neurological conditions (i.e. MS, Epilepsy, Neurodegenerative diseases, etc.), Stroke service and our Neuro-Oncology service which is specifically for patients who have been diagnosed with a brain tumour. In the Neuro-Oncology MDT clinic and under the supervision of a Neuropsychologist, I assess the patient's cognitive function, memory and language abilities to establish a baseline. If a patient is having treatment this baseline helps in monitoring any changes post-treatment. Post-treatment testing involves evaluating the impact of the treatment on cognitive functions and assisting in rehabilitation if needed. For patients undergoing awake craniotomies, the assessment helps the surgical team to monitor and protect brain areas responsible for functions like language and motor skills. Our assessments also play a role in supporting patients' preparedness of the procedure. As part of the MDT, I work closely with other allied health professionals, physiotherapists, occupational therapists and speech and language therapists. Alongside their expert knowledge, I contribute to multidisciplinary discussions about a patient's diagnosis, cognition, treatment, risk assessment and care plan.

Working in Neuropsychology means I work with a wide range of patients of all ages and presentations – every day is different. Working with patients who have received a devasting diagnosis can affect them in different ways. In some instances, it can affect people's behaviour. On occasion I have not known how to respond and felt uncomfortable. The power dynamic in the room has changed, leaving me vulnerable. My boundaries have been pushed and at times I have found it difficult to distance myself from the patient encountering countertransference, transferring my emotions onto the patient. I often reflect on these interactions in supervision using the seven-eyed supervision model (seven different ways of looking at the patient presentation and related relationships) to help me navigate the distinct aspects of the therapeutic process. 

Despite this, I find being an AP in neuropsychology rewarding. It allows me to have a positive impact on patients' lives and advocate for their wellbeing. I can help educate staff who are unfamiliar with working with mental health through our MDTs.

Working closely with individuals therapeutically who have experienced a neurological condition(s) has given me a unique insight into complex presentations of mental health issues, honing my ability to approach cases with a holistic, biopsychosocial perspective.

Since I began this role, I recognise a significant growth in my confidence and knowledge. Working in this environment provides a regular reminder that life is short and unpredictable. It has made me recognise how vulnerable we are, and I am frequently surprised by the resilience patients and their families show when they have been faced with a heartbreaking diagnosis.

Katie: Supporting children through illness; weight management, neuropsychology, diabetes and pain

My main area of work in the Paediatric workstream is the complications of excess weight service. I also work into Paediatric Neuropsychology, Paediatric Pain and Paediatric diabetes, in the community and with outpatients. 

In the complications and excess weight service we work holistically to identify the factors that may be contributing to weight gain and maintaining this. When I began working in the service, we did not have a Clinical Psychologist in place, so I had to embed the role of psychology within the MDT. I also had to establish what the role of the AP working in the service would be. My role is to work with children and young people to support them with any psychological complications such as anxiety, low mood or low self-esteem, we work with them one to one, complete family-based work, group work or consulting with schools and other professionals. The work I complete is based on CBT, CFT and ACT principles, which I have had the opportunity to develop further through this role.

The families that we see are often from a deprived background and the level of safeguarding within this population is high, something that I had not experienced in my previous AP role. Having to make referrals to early help and social care is something that I struggled to begin with. I was worried how this could impact the relationship I had developed with the young person and their family. I am very aware of the connotations involving additional services has. However, many of our families have welcomed this additional support as they acknowledge they are struggling in one way or another. Being able to utilise supervision allowed me to reflect upon this and although this may feel uncomfortable for me to make those referrals ultimately, I am supporting that family and placing the child's needs at the centre of what I do to ensure their health and wellbeing needs are able to be met by their families. 

The role can be highly emotive when exploring the factors that are contributing to weight gain such as traumatic life experiences and bullying, but this shows me how resilient many of the young people are that I work with. This inspires me to advocate for them to improve their lives and the future that they will lead as I believe we should all have an opportunity to thrive and become the best we can be. Many of our families reflect that I am the only one that has listened to them and pushed forward to ensure support for their young person is in place. This is something I always hold in mind during my work and inspires me to come to work every day.

The rewards our work brings us

The most rewarding aspect of our work is the people we have the privilege to work with. Many of our patients have been waiting a long time to be seen, and with no signs of referrals slowing, we aim to make a positive impact on our service by educating others, validating experiences, contribute to the broader understanding of Medical Psychology and inspiring others in the field.

Reflecting on our work lets us share the unique challenges and rewards we face. It highlights the complexities of patient care, the value of empathy, and the impact we have in supporting people with both psychological and physical health needs. We each face the same tough situations - responding to behaviours that challenge, navigating ethical dilemmas, finding effective intervention strategies, and managing complex patient care. Sharing these experiences lets us learn from each other, gain new insights, and enhance our skills to better advocate for our patients' well-being.