Do ever feel like your just putting a plaster over a bigger problem as many nurses are probably compassion fatigued because they're underpaid/overworked in the least funded area of the NHS?

Is modern life good for our state of mind? Should we look to revolutionise work, play, education etc?

Hi Dr. Maddox,

What implications or crossover might your research have with general caregiver burnout?

For example, could your intervention also be utilized to help spouses who also act as caregivers to their loved one to avoid burnout?

What psychological disorder fascinates you the most?

Which is the most difficult to treat?

Since you mention an intriguing phrase - compassion fatigue - how do we handle or deal with friends/colleagues/relatives who are only too happy to go on and on about their stuff without letting you talk about your own stuff?

I think most would know people like these in their life and would agree that it's not always feasible to just "cut things off" with them.

how to change a bad/negative inner-voice? Please and thank you

What are your views/knowledge on microdosing psychedelics to treat psychological disorders?

What are you thoughts on the Power Threat Meaning Framework? What changes would you like to see in the mental health field?

Do you use mindfulness or metra meditation?

Can you tell us about one of your best clinical moments? About one of your worst?

How much of social media do you believe has affected people negatively as in increase of depression?

What is your #1 advice for management of mental health? What is a daily activity that helps the most and what daily activity does the worst for getting optimal mental health?

I think compassionate staff are more able to do their job when supported by compassionate management and commissioners. Shouldn't any compassion intervention be applied systematically through the service? Else you risk a "compassion gap", already present ( imo) between patient facing staff and their non-patient facing management structures.

This reminds me of the resilience training for front line staff. I worry that this scapegoated staff capacity, rather than address unreasonable expectations by their managers and commissioners.

Tldr: Don't mistake a symptom for the disease.

Hi everyone! It's Lucy! Good to be here! Thanks for your questions. I’ll get stuck in!

Great question. Think this absolutely is a risk of interventions which only target individual staff members. The one I am designing is intended to be a multi-level intervention – so to target both staff members with things they can do that might help, and also to try to tackle some of the more systemic problems, via influence on managers and creative thinking about how to overcome massive workloads and tricky rota-ing issues etc. It doesn’t help with the chronic underfunding of the NHS and undervaluing of the nursing profession. I’m really hoping that the current strikes will prompt some engagement from the government and the possibility of some solutions to that.

Wow fab thing to think about. I think it depends on which aspects of modern life and how we are using those aspects. Some things I think are definitely not helpful, for example exam culture for children and young people. Others are more nuanced, for example social media can be both positive and negative depending on how it’s used.

Fab question. I think probably a lot of the same mechanisms are at work, but the context is quite different so would affect how an intervention could be delivered and what would feel acceptable. It’s a huge issue in caregiving in general though. Lots of work done with foster carers too.

Will the book be available in the US?

I think of most psychological diagnoses as on a spectrum with more common experiences, and I suppose I feel fascinated by the relationships with the people who I see rather than thinking about an illness in particular. Having said that I’ve worked a lot in wards with teenagers, and worked with some young people who are experiencing psychosis, and I think that’s one areas which is open to misunderstanding, with people seeing it as something dangerous or totally “other”, when again it is actually a spectrum of experience that we all lie on somewhere. All of us can experience paranoia and lots of people have beliefs that others don’t necessarily share. The difference is when it affects someone’s life negatively.

Hopefully at some point but it isn't yet

For more AMAs on this topic, subscribe to r/IAmA_Academic, and check out our other topic-specific AMA subreddits here.

This is a very interesting new area of research. I don't know enough about it but good people to read/listen to include Suzi Gage who has a fab podcast on all things drugs: https://play.acast.com/s/saywhytodrugs and Val Curren who does really interesting research in this area: https://www.ucl.ac.uk/pals/people/valerie-curran

This sounds tricky... And christmas is a time when we often find ourselves stuck in repeating patterns in relationships with people we have known for a long time. One thing that can sometimes help is thinking about what you can do differently to shift the dynamic slightly. Can you make a conscious effort to talk more about your own stuff and not wait to be asked? The results might be surprising!

Similar situation going on in children's residential homes. We're often working with teens who have just left hospital or secure units but chronic underfunding and lack of appropriately trained/ competent staff combined with ludicrous red tape and unrealistic expectations means all to often they end up going back.

Therapeutically parenting traumatised children and teens is challenging and compassion fatigue is a very real issue that definitely needs greater awareness and intervention. It is, however, something that needs to take place alongside a complete overhaul of health and social care services. My fear is that what sounds like it has great potential would be used to allow complacency with the current standards which are seeing vulnerable people failed on an alarming scale.

ETA wrote this without seeing Dr Lucy had responded. It's great to hear you've acknowledged wider issues and the need for systematic change!

Such an important thing to think about. We spend a lot of time with ourselves and if we're having a go the whole time it can have a negative effect. One question I find useful is to ask yourself what you would say to a good friend. We're often much meaner to ourselves than to someone else we love.

​

This book by Mary Welford is a good one too: https://www.amazon.co.uk/Compassionate-Mind-Approach-Building-Self-Confidence/dp/1780330324/ref=asc_df_1780330324/?tag=googshopuk-21&linkCode=df0&hvadid=310805565966&hvpos=&hvnetw=g&hvrand=18171044736043241899&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9045631&hvtargid=pla-537293131368&psc=1&th=1&psc=1

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And in the new book I just have out one of the chapters is all about speaking to ourselves more kindly (April's chapter). This is on sale at only 99p for a few days if you want the e-book. https://www.amazon.co.uk/Year-Change-Your-Mind-Therapy-ebook/dp/B0B4BTF8RH/ref=tmm_kin_swatch_0?_encoding=UTF8&qid=1671200145&sr=1-1

I use mindfulness, both myself in my personal life and professionally with other people. It's not for everyone but I find it very useful.

The picture here is very interesting and researcher Amy Orben has done some fab work in this area: https://www.amyorben.com

It depends on how we use social media. If we use it to compare ourselves negatively to others and to isolate ourselves then it's unhelpful. If we seek out accounts which are affirming and social links which help us feel connected then it can be helpful.

We need to be careful though, I think, as some dilemmas which occur online e.g. sharing personal photos with wide groups of people, can have devastating effects on young people

Thank you for the response! I will check these out

Yes! Couldn't agree more. I got very interested in the organisational aspects of compassion fatigue. I ended up doing a masters in organisational psychology and thinking about how some of these ideas about workplace conditions might influence staff ability to provide compassionate care. I'm in the very early stages now of a 5 year project but the aim is to develop a multi-level intervention, not something which is just for staff, but which also involves managers and possibly commissioners.

I think that is a real risk which is important to try to guard against. My worry with waiting until there has been a complete overhaul though, as you say, is we may be waiting a while, and if there are some interventions which we know have value, both for staff individually, and at a more team focussed or wider system focussed level, then should we wait or is it good to offer what we can whilst still shouting about the problems in the wider system?

I couldn't agree more! I've got increasingly interested in organisational and systemic elements of compassion fatigue and compassionate care in general. I did a masters in organisational psychology recently and I'm hoping to be able to pull together knowledge about individual level interventions for staff with more organisational level interventional components which tackle work conditions. It's a bit of a tall ask but that's the plan!

Ooh fab question.

I would say that things vary for individuals - there's no one thing, but things that tend to help daily are (obvious but still helpful): trying to move your body, eating well and sleeping enough (if possible!), trying to treat yourself with kindness like you would a good friend, trying to spot things you enjoy and things you feel proud of throughout the day.

Things that are usually unhelpful: too much of any one thing - e.g. too much isolation or too much busyness, not enough rest (even if it's tiny micro rests in the day), beating yourself up about things, ruminating on things that have already happened or worrying too much about things that are out of your control.

It's obviously easier said than done to make changes to these things, but they are worth considering in my opinion! There are more ideas in my most recent book which is only 99p on kindle for a few days: https://www.amazon.co.uk/Year-Change-Your-Mind-Therapy-ebook/dp/B0B4BTF8RH/ref=tmm_kin_swatch_0?_encoding=UTF8&qid=&sr=

Wow that's a tricky one! It's a lovely question actually because it makes me realise that there are so many very special moments. It's always great to feel like therapy has made a difference to someone's life, but even the moments when things are not going so well can feel important, especially if the person is able to tell you that they feel bored or like things aren't helping. It feels like there is a genuine connection and then you can try to do something differently. Many special moments happened when I worked on an adolescent ward in London where I also felt very connected to the team and to my supervisor, as well as to the young people I was working with.

Worst moments... I once got sent home from work because my clinical registration had lapsed without me knowing due to an admin error. It was awful! I had to be escorted from the building and I felt like a criminal! It's obviously very important to make sure that professionals are properly registered so it was absolutely the right thing to do, but it was horrible!

Whoops! Thought this had disappeared so answered it twice!

That's great to hear! I personally feel that the lack of compassion starts at Whitehall and rolls down the hill, ending with a HCA on a 12hr shift, getting yelled at, who then passes the hurt onto the patient.

I'll always remember how one of the Winterbourne view HCAs who was convicted, was voted "most caring" at school, had lots of St John's ambulance experience, wanted to go into nursing. She probably didn't start out abusive, but got there in stages.

What might those stages be? ( Maybe lack of service direction / exhaustion /boredom / suggestiblity?)

It would seem more efficient to start as close to thr top of the pyramid as you can reach (less NHSE /ICB senior leaders to reach, than front line staff).

That's an amazing image of it rolling down the hill. The pressures being passed on feels very true. I think there's also the bit about how people who have been traumatised respond to a system around them and how the trauma influences the system too. It's so complex. Important to recognise anyone could be involved in this as a dilemma though, as you say.

There was an article in The Psychologist magazine this week (the British Psychological Society mag) which summarised a book called Hospitals in Trouble by John Martin. I haven't read the book but the authors said certain quite practical aspects of ward location and culture influenced whether care became poor. The factors included ward location, personal and professional isolation of staff and lack of training opportunities. Obviously this is no excuse for abusive practice but I did think it was interesting to think about what factors could act as roadblocks to make abuse less likely.

Thank for your perspective on intervention efficiency - that's a very helpful thing for me to think about.

Wowser this is a big'un!

Main changes I would like to see in the mental health field relate to adequate funding. There has been so much talk of "parity of esteem" between mental and physical healthcare but I would like to see "parity of funding" and also proper investment in social care and third sector services. I'd also love our knowledge of staff wellbeing and the impact on compassionate care to advance so that we can more effectively help both patients and staff.

Hi Dr Maddox! I found out very recently I have been dissociating for large spells of my life as a defence mechanism from when I used to get in trouble at school. Have you read or heard anything about future improvements to the assessment of mental health for children/young adults?

I feel I’ve missed out on lots of my life and that my memories aren’t my own because I was left to create negative coping mechanisms. It would be great to hear of any plans to prevent this happening as much for people because it can have major impacts on their adult relationships & career.

I’d love your thoughts on CPTSD. I suffer from this and for some reason it’s still very taboo to speak about it generally.

What are some helpful tips to help overcome this issue? If there are any.

Thanks for the questions all! I'll pop back on on Tuesday for half an hour at 10Am (GMT) in case there are any more.

Wishing you all well over this festive bit and into the new year.

Ah! Just seen there are a couple of questions I haven't been able to answer. I will pop back on Tuesday. Sorry to have to go now.

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Hi Dr Lucy, thanks for the interesting AMA! Obviously CBT has dominated as a model for quite a while, but IMO has some issues. Do you think there should be a push for prioritising Compassion Focused Therapy as first port of call over CBT? Also a second question regarding your career overall. Do you have any tips for an aspiring Clinical Psychologist? I'm just about to complete my psychology undergraduate degree but am feeling so overwhelmed as to what to do next. AP positions are limited in my country, would you have any recommendations for getting non AP clinical experience? Thanks so much!

How is someone as a parent supposed to be compassionate and caring towards a child that is a narcissist? My parents adoped a child that was diagnosed as a narcissist after adoption, and has nearly destroyed my parents 40 year marriage. How can compassionate care help in this situation?

You know how I know you're an actual professional clinical psychologist?

You admit something isn't your area of expertise.

Take notes Jordan Peterson, you don't have to pretend to be an expert on everything.

Thank you for taking your time to speak to us!

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It seems like an entire generation of teenagers is suffering from anxiety. Even before Covid. Is there a cause for this, or are we just noticing now?

> I produced a podcast about cognitive behavioural therapy called Let’s Talk About CBT for several years,

will psychology ever move away from having the main treatment for mental illness being based off how other people experience the patient? CBT really only teaches people how to hide symptoms. It hasn't been proven to lead to neurological changes - same for claims of that with DBT.

Full disclosure: I'm a trans woman and active in community outreach and care. I'm tired of burying my friends because of structural problems that I don't feel can be solved as long as we continue to let long standing cultural problems in for-profit medicine and methodological errors that have utterly divorced psychology from the rest of STEM. See also: the publication process for the DSM being shielded behind NDA, the DEA forcing doctors to prescribe off-label medications as first-line choices for treatment of psychiatric conditions, etc., etc.

The plain english here is that I'm tired of watching the results of a system that, when faced with a need for accommodation, tries (violently at times) to force the patient to adapt to a system that has been designed to fail everyone but young white men - a mirror of the demographic composition of psychiatry until about fifteen years ago. Psychology that roots in patriarchal attitudes is toxic as hell but here we are, in 2022, living with life expectancies in the mid-30s across a broad spectrum of my community.

It would be nice to see psychology stop screaming "self care" at people who need community care they won't provide, and instead make the solutions to minority struggles fundamentally reduce to either hiding their problems or doing less and if neither works then medicate them or call it a disability and then kill them slowly from poverty they can't escape.. When in actuality all they needed was someone to hold their hand for awhile.

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Thank you for answering!

And again, you've mentioned something super intriguing: "repeating patterns in relationships with people we have known for a long time."

I have had friends who just won't let go of what happened or what I used to do/be several years ago. Hard to tell if it is out of spite or their inability to let go of the past or what else. Should one move on/get past such people? Is there hope to make them move past these repeating patterns?

Sometimes the brain does extreme things to protect us (although with nasty side-effects), for example in DID/MPD or PTSD. However in schizophrenia it's hard to see that there's any protective benefit at all. Am I missing anything? Is there any utility to it? And is it a natural response to any stimuli?

Thanks in advance

Do you make a distinction between compassion and empathy?

For instance, compassion is an awareness of suffering and a heartfelt wish to alleviate it; while empathy is to feel as another person feels?

I ask because I think the distinction might be important. Extended periods of feeling what others feel can lead to empathy fatigue (checking out and shutting down), but extended periods of wishing to help alleviate suffering don't seem to lead to compassion fatigue.

What do you think?

Hi Lucy, thanks for taking the time to do this! From an aspiring clinical psychologist currently working in a CAHMS inpatient service for teenagers, I have a few questions - please feel free to answer whichever you feel like.

1. Your intervention sounds really interesting! I also hold an interest in compassionate care and compassion-focused therapy. What will your intervention comprise of, and how are you planning on evaluating it? Do you have any papers published or registered for this yet? I'm keen to have a read!
2. How do you approach self-practice and self-reflection if at all (i.e. outside of teamwork reflective practice and supervision)? Do you take a freeform approach or utilise a framework? Do you write, record, or just think? Has this changed from the early days in your professional development?
3. If you could choose one book (other than your own) to recommend to someone entering the field, what would it be? This can be as loosely or as closely related to the profession as you like.

Thanks in advance! :)

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Hi!

I am looking to go into Clinical Psychology, I am doing an Undergraduate degree in Psychology. Do you have any advice? I am attempting to gain as much clinical experience as possible!

How do you respond if someone tells you things aren't going well? Are therapists taught how to do this? Does the response affect therapy going forward?

By "people who have been traumatised respond to a system around them and how the trauma influences the system too" do you mean that people working in Health & Social Care have often had difficult life experiences which affect how they respond & that can also feed back into a vicious cycle?

I was wondering about a more straightforward or prosaic effect of uncaring/abusive management>systems which reward suboptimal care>having to switch off to avoid moral injury>high likelihood of being uncaring and increased likelihood of being abusive.

I worked for a while in a social care dept where the criteria for receiving social care were being revised. I was an assistant OT, trained in equipment provision only to help make tasks easier where people were struggling (not where they had stopped altogether), but would get referrals like "Due to changes Mrs X is losing her lunchtime meal prep visit, please work with her on food preparation, she hasn't done this for 5 years". I asked for supervision from a qualified OT, which was refused. Management cared mainly about throughput. I left. The only way I could have stayed and not had a breakdown would have been to disengage from caring about the people we worked with.

I hope you & Lucy don't mind if I jump in here with my own 2p worth! I had Compassion Focused Therapy (CFT) for several years & found it of very limited effectiveness. Some techniques e.g. imagining looking at your ideal compassionate self from the outside were actively unhelpful. Eventually I received a diagnosis of OCD and had OCD specific CBT. Made more progress in 20 sessions than in years of CFT.

My sense, from personal experience, hearing other people's experiences, studying psychology and working for a short time in mental health research is that different things work for different conditions & people. Usually there will be evidence pointing towards a particular treatment for the person's diagnosis, which is where treatment should start. If it doesn't help then need to give careful thought as to why before next steps.

Compassion fatigue, is that not similar to work induced trauma by proxy? ie specific to mental health care?

Btw, slightly off topic, but if you’re interested in systemic problems that interfere with clinical psychology treatment - DM me...

...I have a story that’s in the public interest, because whenever the care system cannot help a seriously ill service user, you’re looking at an SAI.

Hey Dr Maddox! Thank you for doing this AMA :) this is going to be a little personal, and trigger warning for those with trauma.

I've had a lot of experience recently with my partner going through multiple UK NHS services for their undiagnosed chronic pain and severe PTSD from childhood trauma they're still working through. They find the physical pain can lead to suicidal thoughts.

Each time they're suffering and a doctor speaks to them, my partner is extremely adverse to being honest about their suicidal thoughts as it leads to them being put in mental institutions that they feel have been unsafe and triggering while their physical condition goes untreated. As their partner and carer, I can understand their incredible reluctance to continue engaging with professionals who can help them, as my partner feels they do not truly understand or listen to their troubles.

My question is this; what can be done and what changes need to be put in place to overcome this block between doctor and patient, and what can we as individuals do who have suffered what we feel is a lack of compassionate care in the system?

Hello Dr. Maddox, I’m in undergrad and I hope to be a clinical psychologist one day. I wanted to ask 2 things, Is there anything that sticks out to you in clinical settings that should be widely improved upon in terms of mental illness treatment? And how do you feel about the work you do?

Edit: I actually have a third question that just occurred to me, is there anything you would recommend to any newer students that are aiming to be clinical psychologists? I am personally interested.

Is it available in the US?

How much of a prominent role does the big 5 factor into your work, for instance do certain traits such neuroticism and agreeableness play into the risk of developing compassion fatigue?

Is slat at bath university called “Bath salts”?

Is reduced compassion fatigue a good thing? If all other factors remain the same but the staff continue to genuinely care and be emotionally invested for longer, do we know what effect that will have on burnout, mental health of staff, and retention?

Hi Dr. Maddox,

Just in case you see this when you're back online, I thought it'd be interesting to get your insight on this:

For those of us who might use psychologists, is there any specific certification we can check for therapists claiming to deal with specific issues?

I was recently seeing a psychologist for something that she claimed to have expertise in, and the more sessions I did, the more it became clear she was definitely not trained in dealing with them.

Is there some way to check this in case I decide to go back into it?

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On compassion fatigue as a dynamic in a longer term situation, what are ways to address resentment issues? Thanks for your time.

The answer is, as always, broad economic and social reform, but since they profit from the system as it is, nothing will be done. Psychology is a joke field. Always has been. Therapy is a crap shoot and almost never works, it just teaches you how to hide your symptoms. Then they foist highly addictive meds on you. It’s an embarrassment.

As a social worker in direct service

Not the Dr but every good therapist hopes to be told if the patient feels like the treatment is not going well. I can't overstate it that they want to get feedback on what does and does not work

Hi Lucy, I’m an RMN working in a community adult access team, I have experience in female and male forensics, community affective disorders and CAMHS inpatients. I have a bit of a passion for trauma informed care probably to the point that I think almost all mental health diagnoses stem from a form of PTSD. For me the barriers to compassionate care at the moment come mainly from staffing and burnout related issues. It’s hard to give patients your best when the staff team are spread so thinly. In CAMHS I found patients attitude towards each other made things difficult as well as the attitude of their parents, I think the complaint culture we have gotten into plays a big part in this as well, as we are scared to do our jobs in some ways due to fear of litigation if something goes wrong. I think being able to recognise when staff are burned out and rotating them for a while would be great but rarely happens, especially if you work somewhere like a PICU where it’s hard to recruit to. Do you think that the staffing problems we have now, such as a heavy reliance on agency staff, mean that patients are not getting good, compassionate care and continuity in their care?

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Just wrote an absolute essay and then saw this 😂

Hey im a recently graduated psychologist and i have found difficulty finding employment, on a personal level do you have any advise that could improve my chances?

It seems you might not have full understanding of how CBT works and its scientifically proven benefits? Or maybe it did not work for you or someone close to you? Personally, it has helped me overcome many negative thought and behavioural patterns, it has helped me reflect over my thoughts and actions as well as giving me a great set of tools to tackle worry and anxiety.

I highly recommend it, but we do need to bear in mind CBT is not a fit for all and every challenge of the mind. That said, it has been scientifically proven to be more effective on more than most treatments, for a number of conditions.

Is it hard to become a clinical psychologist and does it require a big knowledge of math? I want to become one but math really isn't my strong suit.

Edit: Why was I downvoted???

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What are your thoughts on Canada expanding medically-assisted deaths to the mentally ill?

what you think that people about actually need controlled substances but they're never getting because of their look or history of drug abuse and how they should handle this situation? what we should do without going psych ward?

In your opinion, what effect did COVID isolation in mental health wards (i.e. patients admitted to hospital for psych issues who also tested positive for COVID and were placed under isolation rules as well) have on ward staff and patient outcomes?

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I appreciate the sentiment but it's not a joke field. At best, its practitioners in this country are misled by patriarchal and racist attitudes endemic to medicine as a whole. Therapy does work, i happen to run a queer/nd support group for teens and young adults in the community. I'm neither, btw. But I'm trans and I know group therapy is basically queer culture because of how much trauma we carry around. So I help. And we speak to each other about what our therapists say too, both to support and criticize. We put it all out there because that's how we heal.

I'm sorry they hurt you too. I have my own grudge with the establishment, but there are good people - good therapists out there. I have one now - a nature and dog loving lesbian with a heart of gold (and maybe drinks more than they should, but I'm not judging). But she can't solve all my problems. In truth, I'm not sure anyone can. But she does make me feel like I'm not alone in the world and that...

Well, that's what therapy is for: Figuring out how to connect in a disconnected world.

Any way to buy your book in the US?

So it’s not a medical treatment, is a random crapshoot that doesn’t work for most people, and is compensated for through psychotropic drugs? It’s not a real field, it’s quackery. It’s where you go when there’s no other option. If I wanted to pay someone to pretend to care about my problems, I’d hire a prostitute. I’d be cheaper than paying for a therapist.

>group therapy is basically queer culture

You said it.

It's not exactly a secret.

Okay. Well, you get functional enough to afford the hookers and blow then, and the rest of us will keep working on our negative cognitions because we're not rich enough to afford your brand of mental illness health.

Or that your just saturating an already super over-saturated self-help market? Or are there some novel ideas in your book?

Okay everyone! u/VoidsIncision doesn’t buy it, wrap things up and get back to work! He knows someone and he’s clocked onto us and our lambos.

First off, if you want to compare salaries using the median would be more representative than the mean.

Secondly, the salaries are on the Agenda for Change salary guidance.

Band 5 nurses:

• <2 years' experience £27,055
• 2-4 years £29,180
• 4+ years £32,934

Of course there are all sorts of fees that eat into that. For example having to pay to park at work. My hospital was £18/shift if you couldn’t get a staff pass to reduce it to about £8/shift, but they were always out of them anyways.

There are also exams, professional registrations, and other costs which chip away at that.

I’m a doctor (thankfully leaving medicine in a few weeks forever for a new non-medical job!) and last year i spent:

• £1546 on mandatory exams
• £433 for the GMC - mandatory annual fee
• £453 for the GMC - mandatory certificate
• £479 for the BMA
• £850 on “optional but not really because if you dont them you’re behind everyone else” courses

total: £3760 just to keep working.

More expensive are things like the opportunity cost of not buying a house because I was thrown about the country every few months and the massive student loans.

but hey after 4 university degrees and a decade of training I broke £60k last year by like £200 so who am I to complain? It’s more than the median! Thankfully my non-medical job will pay well and my backup was moving to Canada which again pays more for less work so my complaints were ending either way. I wonder if I would’ve had your permission to complain when I worked Christmas covering ~200 patients for £12.something per hour. Or if that was okay because hey, more than the median.

My therapist cost me 180 dollars per visit for an hour. A prostitute costs around 100 dollars an hour. Which is more cost efficient if they perform the same function? Therapy is an expensive luxury that often doesn’t even work.

Looking forward to seeing you in group when you lose the self hating incel crap and actually try instead of mistaking an endless search for a crutch that will let you stay toxic for therapy. And i mean that sincerely - about one in five teens i work with now came from a conservative upbringing and have so much internalized ableism and homophobia I have cried after... Because of how much they have grown in just a few months around their peers who are helping them lose that attitude. Go to therapy or don't, but find a support group (or make one). You've been alone too long. I know from experience.

Also, at a societal level - consider that most therapists are paid garbage working for most health care organizations. They could go into private practice (or be a stripper, since you mentioned) and make more but they don't. Do you know why? a lot of them, not all, or even most, but a lot - actually do care. when you find one, and open up, then maybe you'll find therapy is worth every damn penny and then some.

I think therapists should be paid triple what they are today because of how desperately we ALL need competent, effective, and compassionate care. I didn't come here just to be a crank - I came looking for perspectives I haven't heard before. I pity people who only ask questions to confirm their biases, not challenge them.

How do you get someone to grieve?

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If you are UK based:

• Get a degree that gives GBC. I think every Psychology undergraduate degree is BPs accredited and gives GBC, but if yours isn't you'll have to complete a Masters that does give GBC.

• try to get a 2:1 or higher. It is not impossible to become a clin psych with a 2:2 but it's much harder. Some universities would only offer you a place if you have a "high 2:1 or better".

• if you get a 1st class honours that's great, focus on clinical experience. Assistant Psychologist roles are the best route for this, but Psychological Wellbeing Practitioner is also another valued role. Although just to warn you, the latter is associated with high levels of stress and burnout and there's some talk of "locking" trainees into the role, meaning they can't leave for 2 years post-qualification. Research assistant roles can also be good for research experience. Just to warn you that these roles are very competitive amd you will likely need experience prior to getting them e.g as a support worker. If financially feasible you could also get experience in a voluntary role.

• if you don't get a 1st class honours (I.e 2:1 or 2:2), I'd suggest following the previous steps but maybe also consider doing a Masters to further prove your academic competence.

• choose which courses you want to apply for purposefully. Some may have entry requirements that don't suit you. For example a couple institutions count your A level results, some require you to take tests of GMA, etc.

• be prepared for a really competitive field. I'd only recommend it if you are truly passionate and focused on it as a career. I'd say most people are looking at 3-4 years minimum of experience after undergraduate before they get onto the course, which is then another 3 years. I was fortunate to get onto the course with "only" 2.5 years of experience. Most of my colleagues have more.

Support worker is good experience prior to being an AP.

Research assistant can also be good experience

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Can you elaborate a bit more on the harm in the exam culture?

Not OP obviously but this thread is relevant to my journey. As a complete amateur, take this for what it's worth .

You can't change other people, ultimately. Your friends may be stuck on the past but you are not. You can change and you can point this out to your friends, but ultimately they decide for themselves what they want to believe and how they respond to you.

If they won't change and you have, then you have choices to make. You can continue as you have and put up with the frustration. You could cut them off completely if it's bad enough. Or you can set boundaries and enforce them. Ultimately that is your choice.

I've been through this with both sides of my family, my spouse and my kids. Been through the phase of demanding they change. It just doesn't work. No one likes to be told they are wrong.

So work on yourself. Be comfortable with yourself and your past. If you hurt them, apologize. Make amends. If they can't move on then maybe you should. But you can also leave the door open to reconciling in the future if they do change. If you do not act on your own, that's where the pattern repeats and you get stuck.

I kind of view it like my relationship with my therapist. They are not really my friend but they are friendly. They are there to give me advice from their experience and training. I accept their influence or I do not. We've had three therapists in the past decade, each was good for some things/areas, not so good for other things. Make progress in one area then move on. Do some self work as well.

It's a journey. It moves at different speeds. Sometimes slow, sometimes amazingly fast.

The good therapists have absolutely been worth their fees. They have helped me see things I could not on my own. I've done a lot on my own but with their guidance.

Thank you for taking the time to respond with a thoughtful answer. Short vent follows.

I made a mistake by staying in my comfort zone and sticking with the two friends I had for a long time. I felt the direst consequently this year when at my lowest point, the very friends abandoned me, citing hurts from years, even decades past and haven't spoken in months.

You're right that it's a recipe for disappointment to expect others to change. Moreover, it gets progressively harder to make good friends in life - atleast that's been my experience - you're left with less time as you get into your 30s : you cant really rush closeness or real connection. With more and more people finding a partner or starting a family you eventually turn into a bit of an outcast...

I've benefitted from therapy as well - had to stop since I was moving countries, but perhaps it's time to restart it.

Thanks for your response! I am glad you found my response useful. Its just my opinion based on my experience. Wishing you all the best!

What do you think about the possibility that “compassion fatigue “ is an honest assessment of reality. I work(ed) in the arena of homeless services and permanent supportive housing where self sufficiency is voluntary. I’ve seen so many people give up because they’re just waiting for their free apartment and case management services. Why should I bust my butt as a taxpayer to support those folks? What are your thoughts about that?

Thanks!

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Is it true that Bath university has been experiencing an extreme funding crunch because of competition from Shower University and Hot Tub University?!

Why is this not just yet another novel length exercise in avoiding saying that the problem is obviously capitalism?

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Also another angle, we in developed countries look at the clients with compassion because they have low funding, always micro-managed, controled food and spending etc. whereas I have heard from staff from underdeveloped countries that people with these problem get 0 help or funding. People from underprivileged countries might look at these clients as “privileged” compared to the people they have seen back home. Is our compassion based on the comparison of our own quality of life?

As someone working at Bath University, have you developed an opinion on whether "Bath" is a funny name for a place?

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thank you, have a wonderful day!

Talking about teenagers specifically, a total lack of resilience when it comes to very ordinary day to day issues seems to be on the increase:

Being asked to do something they don’t want to do = meltdown

Making a mistake socially or academically = meltdown

What is going on?

Me, too!

What is your opinion of PsyPost.org as an outlet for journalism on peer reviewed psychological studies?

Can you help me with accomodations for work ?

Is it true that in British, your school would be pronounced as like "Bawth" instead of "Bath"?

He said he rents prostitutes, so he's not celibate. We call them neckbeards when they have sex.

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>Although just to warn you, the latter is associated with high levels of stress and burnout and there's some talk of "locking" trainees into the role, meaning they can't leave for 2 years post-qualification

I think they've already done this. It's as sad as it is funny, really: 'people are leaving this really stressful, underpaid job. How can we fix this? I know, how about we force them to stay?' Brilliant.

>be prepared for a really competitive field. I'd only recommend it if you are truly passionate and focused on it as a career. I'd say most people are looking at 3-4 years minimum of experience after undergraduate before they get onto the course, which is then another 3 years. I was fortunate to get onto the course with "only" 2.5 years of experience. Most of my colleagues have more.

What do you think helped you stand out to get on sooner than your peers? What do you think you might have done if you couldn't become a psychologist?

I'm passionate about it, but it's very depressing to read about how hard it is, and I can only imagine it's going to be harder than ever with the increased levels of graduates due to covid policy mess. Also my university seems to be stingier with 1sts; the number of people who get them supposedly goes up every year, and at my university 35% of people overall get firsts, yet for psychology in all the reports they have given out so far for any assignment I've done, only like 10% of people, max, are getting 1sts in their assignments. Very few people are going to be graduating with 1sts overall, and I'm not sure I'll be one of them. There's definitely the thought of saying 'screw it' and studying for a conversion course in computer science for an easier life, even though I'm not passionate about that.

Take a step back.

What is stopping you from just giving up, and getting a free apartment? It would be easier than busting your ass as a tax payer right?

Healthy people don't act that way. Healthy people want to be doing things. They want to be connected with others. They want to be productive.

And yes, there are people who are unhealthy AND have issues like being lazy, or entitled, etc, but those issues aren't actually fixed by punishing them.

In fact, your taxpayer ass probably pays more for the people out on the street. (Atleast that's true in my country).

So if you pay more for people out on the street, are you actually upset about paying for their house? Or is there some sort of value judgment connected to it?..do you think they don't "deserve" it?

Can you post any third party reviews of the book?

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Is Bath university where you go to study taking baths?

Can you say that again, but as Haiku? 🙃

Perhaps in the future

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Thank you for your reply 🙂

Damn that sucks. PWP is still a great job for experience but being locked in makes it hard to recommend when the stress can be unhealthy.

It is competitive but if it's what you want to do I'd still encourage going for it. There are many other job routes other than Clinical Psychology if it doesn't work out. You can become a CBT therapist, or look at a Health Psychology route, or a PhD if you like research. I think I'd have kept trying for the doctorate if I hadn't got on at least for a few more years (I know some people that take 5+ attempts to get on).

My backup career outside mental health was data analysis/data science, or some research position.

Don't worry too much if you don't get a first. As long as you can show you're academically capable, that's what's needed. Experience + clinical skills are what most institutions look for.

Everyone looks at the pay and compares it to to average, but then completely ignore the fact that:

• this is often after a decade of gaining experience

• these also include some of the highest performing academically capable people

I'm privileged to be in a role with almost guaranteed progression to earning about £60k. But at the same time, I could earn most twice that if I'd gone into Data Science and worked for a private company. Or even just moved to Canada doing the same job!

Thanks for the response! Whilst I've got you, could I pester you to answer a few more questions?

1. Is being a psychologist what you dreamed it would be?
2. If you could go back and give advice to yourself when you were younger, what might you say?
3. I'm a guy. I've noticed that most psychologists, and certainly people on my course, are women. Do you have any idea why this might be, and have you found this to be the case where you work? I'm kinda hoping this will make me stand out a bit amongst the hordes of candidates.
4. You mentioned data science. I've used a bit of R and psychology obviously involves some statistical analysis etc., but do you think that would've been an easy transition? What were your thoughts there? Sounds like maybe you had a similar back-up plan to me and my idea of a computer science conversion.

I'm definitely going to soldier on and hope to become a psychologist for now. But that voice at the back of my head does make me question it sometimes, especially since I'm a mature student, so spending another 6-10 years before I become a psychologist in the best of cases wouldn't be ideal. But it's hard to imagine being satisfied in life if I don't give it a shot.

Thanks again.

May I ask what you're planning to change careers to? Seems a shame to have gone through all that training only to do something else.

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1. Since I was about 16 I wanted to be a clinical psychologist. It was my main goal since then.

2. I'm not sure!

3. Yes Clinical Psychology is about 80% women. Probably lots of societal factors explain that difference. I don't think being a man or woman is a benefit or weakness.

4. I taught myself R to do the statistical analysis for my dissertation and I really enjoyed it. I figured if I could teach myself R during an undergraduate dissertation, that I could learn enough to become a data analyst, and from there transition into data science. I have no idea how realistic it was, but I think it would have worked if I put my mind to it.

On that note, if you are interested in quantitative analysis/maths I would recommend doing further learning yourself where possible. If you are a mature student does that mean you live at home as opposed to rooming with students? I lived at home and I think this gave me a good advantage over my peers. I wasn't surrounded by alcohol and drama and noise. This gave me the opportunity to work much harder. This is why I was able to do extracurricular reading and learn skills such as R. There's a great course by Daniel Lakens online about p-values and frequentist statistics. If you go through it you will end up knowing more than not just your peers, but a lot of the lecturers and clinical psychologists too. This then allows you an extra perspective in being able to critique research which is a really important skill in psychology.

On the topic of career, it depends on your goals. Spending another 6-10 years to become a clinical psychologist can sound daunting, but you need to reframe it. You will be spending that time learning really valuable skills, earning some money (most roles are band 5 so ~27k). For example, to some people being a PWP is their entire career. Or some will progress to Senior PWP and Band 6. There's also a new role as a Clinical Associate Applied Practitioner (or something like that), which is Band 6 (or Band 7 in Wales) and can function as a career or a step to Clinical Psychology (although like a pwp, locks you in for 2 years).

P.s I've mentioned a lot about working hard, but I also spent a lot of time doing other things like gaming, watching football, going on walks, etc. You need a work life balance.

Why the downvote, thought it was a legit question ?

>Since I was about 16 I wanted to be a clinical psychologist. It was my main goal since then.

Ah, I think you misinterpreted my question. I was asking whether it lived up to your dreams. Is it as satisfying as you hoped?

I'll check out the course, thanks. And true, there's definitely various options to consider with careers, it's not all or nothing. I'd also consider applying to graduate entry medicine which is again super competitive but I think the experience I'd be gaining would tick a lot of the boxes for that. Did you go down the support worker -> pwp/ap -> doctorate route?

Sure thing! I’ll be utilising the knowledge and skills I gained over the years, they haven’t gone to waste.

I’m switching to medical affairs for a pharmaceutical company. I also received offers for management consulting. Any UK medics reading this considering leaving, there are options! Feel free to message if you have questions.

If I had switched earlier I’d have been less burnt out and bitter about my experience and significantly better off financially by now. I never dreamt of one day leaving medicine and I generally try to live a life without regrets, but if I had to pick one it would be applying to medical school. Considering a significant portion of my medical friends have left or are thinking of leaving medicine, or have gone abroad, I think it’s a common sentiment.

Hello! I'm back for half an hour now to answer a few more queries!

Hi! Firstly, I am really sorry that you've had this experience. I hope you've got good support around you now. It's really difficult to feel like you've missed out on a lot. I hope you have found someone to talk to about the negative coping mechanisms you mention too - to help with finding and practising alternatives.

In terms of improvements to assessment of mental health in children now - it depends which country you are in as to what is available, but in the UK there is a new initiative to bring mental health workers into schools with a new type of worker (educational mental health practitioners). Historically sometimes clinical psychologists or counsellors were embedded in schools but funding for this dwindled and the new EMHPs are a response to try to get to students earlier if they are having problems. It has only just started so it's too soon to say how it's going but I think the idea of getting in early is a good one. There are also some fab research projects looking at early intervention, for example CUES: https://cues-ed.co.uk/what-we-do/

Sorry! Will try to find your question!

Thank the person for letting me know and problem solve together what would be helpful going forward. It's really helpful to have feedback!

Not yet but hopefully soon! This article has some of the ideas from the December chapter in https://www.bps.org.uk/psychologist/coping-christmas

Hi! I'm a big fan of compassion focussed therapy but I don't think the evidence base is there to suggest it should be prioritised over CBT. I think it's important to be guided by what the evidence says is most effective, and for a lot of problems that is CBT at the moment. It doesn't mean that won't change as more studies are done with other modalities though. I also think patient choice is important - giving people the information about what the research says helps, but also telling them what the different therapies are like so they can be involved in the decision making. One of the reasons I made the podcast Let's Talk About CBT was to demystify the different types of therapies which are based on cognitive behavioural principles. There's an episode on CFT in there too! https://letstalkaboutcbt.libsyn.com

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With clinical psychology - if AP positions are hard to find you might have more luck with a research assistant post on a study which has clinical components. Voluntary work can also help if you are able to do a bit of that on the side (e.g. things like phone lines often provide training). Good luck!

Ah thank you!

Hello!

I'm really sorry to hear you have complex post traumatic stress disorder. That's so difficult to live with. I would really recommend seeking some professional help with it if you can - if you are in the UK your GP is usually first point of access or you can self refer to some Improving Access to Psychological Therapies services. If the waitlists are too long then private therapists often often sliding scales of fees. It's important to get someone who has training and experience in dealing with CPTSD. If it is related to childhood experiences then this book is also a good resource - although not a substitute for individual therapy https://www.amazon.co.uk/Overcoming-Childhood-Trauma-Helen-Kennerley/dp/1841190810

Best of luck with it.

Aha I found your question! Thank you for writing this. I'm so sorry that things are so hard at the moment. It feels like things have always been difficult but in recent years have really bene stretched so so thin. I do think that staffing problems contribute to barriers to care. That's not to say that some agency staff aren't brilliant, but I think it's harder to have the same sense of continuity and team cohesion. It's also so stressful for the senior nurses managing the rota and trying to fill shifts. I do also think there is hope though because retention of staff is better in some wards than others, so I think we can learn from what is working in some places as well as from the research.

This is a really great point. I think they are different too. Some people have made a similar argument to yours: https://www.researchgate.net/publication/336746147_Contesting_the_term_%27compassion_fatigue%27_Integrating_findings_from_social_neuroscience_and_self-care_research

I think we maybe don't know quite enough about the subtleties of the differences yet, but this is something I'm trying to get my head around at the moment.

Hi!

Firstly I am really sorry, that your partner had these experiences and that you have both had to manage difficulties with the healthcare systems in response.

I think there is no easy answer to this one, and unfortunately the risk assessment questions which are needed from a clinical point of view can feel like they get in the way sometimes. They are the best tool we have and it's important to try to assess risk but they're not a very good one.

In terms of what can be done in response to a lack of compassion - I think it depends on your level of energy partly. You could write to an individual clinician to give feedback, or it's always possible to complain - in the UK the Patient Advisory and Liaison Service is independent and can manage complaints about the service you have been involved with. Making a complaint means it gets put on record and the clinicians involved will get that feedback, which hopefully will help improve the service. However it depends on whether you feel that this would be helpful for you as well - if you feel like you have the time and inclination to put a complaint together. I'm not saying this to put you off at all - just to acknowledge that this can sometimes feel like an extra burden.

Whatever you decide, I really hope you find some support which is helpful for both your partner and you.

Hi! Such a good question. It's very confusing I think to find this sort of information out clearly. Clinical Psychologists should be registered with the Health and Care Professions Council (HCPC) but this doesn't tell you about specialisms. You can ask them though - have you had special training in this, do you have any accreditation, what is your experience? For example CBT therapists are often accredited with the British Association for Behavioural and Cognitive Psychotherapies. I'm really sorry you had this experience though - it's not good. I hope you were able to give feedback. If they are a clinical psychologist you can also complain to the HCPC, or through the NHS service if it was through one of those. Best of luck and hope you find a therapist who is more helpful.

Not yet but hopefully soon! Article here is based on some of the chapter on December: https://www.bps.org.uk/psychologist/coping-christmas

Some are quoted on the amazon page: https://www.amazon.co.uk/Year-Change-Your-Mind-Therapy/dp/1838959092

Very happily for me it was one of Apple books' best books of December and also one of the Independent's best books of December.

Not necessarily the case for everyone but sometimes strong unusual thoughts might be protective against things in reality which feel very hard to manage.

It has some stats involved but you get taught that. Don't let it put you off!

Hello! I'm nearly out of time again but here's a paper I published recently: https://pubmed.ncbi.nlm.nih.gov/35915459/

And self-reflection is hugely important. I use a mix of things - supervision and writing and peer supervision. I probably use self reflection and peer supervision more as time goes on but it's still really important to have regular supervision from someone who is just doing this for you - we can all have unconscious biases and can benefit from someone helping us to spot them and improve our practice.

This is really helpful, thank you!

ooh and the book - I'd recommend Yalom - Love's Executioner. It's quite psychodynamic in model which is not what I use but it's brilliantly written and I like the way he acknowledges his mistakes.

Research jobs in clinical settings can be good, support worker posts, charity roles, voluntary work (e.g. Childline or Samaritans). There are lots of ways to get experience and see if you like the role. Talk to clinical psychologists if you can too to get a sense of what the role is like and also what other roles are around. Good luck!

Hello! I'm afraid I have to go now. Thanks so much for all the questions - I answered as many as I could - if I didn't get to yours have a look through the others - it might be answered there.

Wishing you all a good festive period. Here's an article on coping with christmas in case it's helpful: https://www.bps.org.uk/psychologist/coping-christmas

Thanks for the reply, looking forward to it!

OK, that makes sense. Thank you.

Thanks for the info! 2nd part to the question if you don’t mind, do you think there is a risk if children are put through therapy too early and latch onto a diagnosis such as dyslexia and then not try to push themselves because they feel they have a condition stopping them?

Thank you so much!

Thanks again! Yes I've actually had this recommended to me by a friend recently so I'll definitely give it a read!

hi! i have agoraphobia and i was wondering what the best therapy is besides CBT? also, is there a workaround for CBT so is doesn’t cost so much? thank you!

I have bipolar disorder, why do i refuse to take my meds?

If I message you personally, will you respond?

@ age42 Is it typical to have ideas about a loved one's (husband) death and experience panic?

I've spent the last three years trying to figure out a startup. That gave me enough time to reflect on my past. Additionally, I'm starting to develop traumatic anxiety about losing my husband. I'm not sure how to go past this emotion. any idea/suggestion/. help/ guidance appreciated.