Five ways to beat the January blues

I hate January. It’s dark, it’s cold and Christmas is over. I’ve gained Christmas weight and am distinctly poorer than I was in December. I sorely miss the Christmas decorations and feel robbed of the fairy lights which, only days ago, adorned windows everywhere. The next bank holiday is months away. It’s fair to say that I’m familiar with the January blues, a widely experienced phenomenon thought to peak on ‘Blue Monday’, the third Monday in January which is considered to be the most depressing day of the year. Since January is here again and will be happening every day until February, I thought it was a good time to write some evidence-based tips on how to beat the January blues.

1. Look for the silver lining 

Being able to look for the positives in situations, the ‘silver lining’, is a key feature of optimism. This is not about putting a positive spin on negative events or denying their dismal reality. Instead, it’s about being able to find even one positive element in an otherwise grey situation. Studies have suggested that taking a silver-linings approach to life helps boost creativity and could be useful for coping with disaster situations.

The truth is, alongside February, January is the most unpopular month of the year, for obvious reasons. However, it still comes with some silver linings. For example, January is lighter than December, with nearly 30 minutes more daylight each day on average. In that sense, the worst of winter has already passed. The sun still rises relatively late though – around 8am all month. So, if you’ve ever wanted to watch the sun rise from some beautiful location, now is a great time to do it. Leave it until June and you’ll have to get there before 4am for the same event.

January is also a good time for buying certain types of seasonal fruits and vegetables, including apples, pears and beetroot – they are usually cheaper in January than later in the year. In fact, the general lull of January also means that it’s a good time to buy – well – almost anything. It’s one of the cheapest times to travel, to buy a tv or to take out a new gym membership. In the next few months, the price of most things climbs. And, despite its general quietness, there are a handful of great events during January, including Chinese New Year, Glasgow’s Celtic Connections Festival and Burns’ Night. Overall, it’s fair to conclude that January pretty much sucks, but it has some silver linings.

how to beat the January blues

2. Build plus points into your day

If you’re still struggling to think of any silver linings to help beat the January blues, create some by building small positive events into your day. Cognitive Behaviour Therapists call this ‘positive event scheduling’ and it has been shown to effectively reduce the risk of depressed mood. These events should be small things which lift your mood and give you something to look forward to. Write them down and schedule when you’ll do them. For example, it could be as simple as promising yourself an 11am latte and making the time to fetch it. You might then plan in some time to read a magazine or take a brief walk at lunch time. In the evening, you might plan to catch up on a tv show you like, take a bath or spend some time on a hobby. The basic idea is: think of things you like doing and schedule them in. This way, you’re more likely to do them, and you might even look forward to them. Despite a general cultural push to spend January living austerely (think, New Year’s resolutions, dry January, Veganuary), it’s important to allow some small indulgences when you have the January blues. 

3. Focus your attention outside yourself

Feeling blue often comes with an excess of self-focused attention. In other words, being stuck in your own head. This can be in the form of rumination – going over and over past events, wondering ‘Did I do the right thing? Why did that happen?’ It can also be in the form of worrying – thinking about all the things that could go wrong in the future, and how you might cope with them. One way to combat this is to purposely focus your attention on other things that interest you. Depending on your personality, this might involve joining a new class or community group to learn a new skill or help a good cause. It might include going to the book shop and picking up some books about an issue or topic that interests you. One of my favourite ways to ‘get out of my head’ is to listen to podcasts, as I can listen to these when I’m commuting, cleaning up or doing almost any menial chore. Click here to see a round up of some of my favourite podcasts from 2019. The bottom line is – taking an interest in something new that captures your attention, even if only for brief periods, can help beat the January blues.

4. Exercise

Exercise has been touted by some as the ‘magic bullet’ for mental health. While this is definitely an overstatement, there is now strong evidence that it has a consistent, beneficial effect on lifting low mood. One study suggests that this may be because exercise reduces blood serotonin levels, similar to the effects of pharmaceutical antidepressants. If the thought of vigorous exercise makes you want to pull the curtains and switch on the TV though, it’s important to note that even gentle exercise like walking has benefits too. 

How to beat the January blues exercise

5. Get a good night’s sleep

In the winter months it is harder to sleep. This seems paradoxical to me: I would have assumed that long, dark nights mean ample time for undisturbed rest, but the opposite seems to be true. Studies show that in the northern hemisphere, winter increases the risk of delayed bed times, trouble falling asleep, trouble staying asleep and general poor sleep quality. It is thought that this is caused by the way that light effects our hormones – with the earlier morning light of spring ‘setting’ our biological clock earlier (and more effectively). Poor sleep is a risk factor for a wide range of mental health problems including depression and anxiety. To improve sleep quality there are a range of steps you can take, including taking time to relax in the evening and getting as much light exposure during the day as possible. See this article by healthline.com for a great list of suggestions.

Top healthcare and psychology podcasts from 2019

2019 was the year I discovered podcasts. I’m not alone – it’s estimated that there are currently 800 000 podcasts, an increase of 250 000 since the middle on 2018. Here, I share some of my favourites. While most of these aren’t targeted specifically at health or psychology audiences, they all tackle events or issues likely to appeal to people working or studying in these areas, including everything from healthcare scandals to recorded counselling sessions.

 

Dr Death

dr death podcast
This was the most shocking podcast I listened to in 2019. It charts the story of
Christopher Duntsch, a US neurosurgeon who claimed to be the best in Dallas. He has since been convicted of maiming one of his patients and sentenced to life imprisonment. Altogether, he is thought to have caused the death and maiming of 33 patients. The show has been criticised for sensationalising the story for entertainment and is certainly not told in the style of a documentary. However, for anyone interested in healthcare safety, it’s a horrifying, absorbing cautionary tale on what can happen when adequate safeguards are not in place to ensure professional standards. From Wondery, Dr Death is hosted by Laura Beil and is available to download from Apple podcasts and Spotify.  

 

PsychCrunch

PsychCrunch podcast

If you’ve ever wondered how you can improve your commitment to exercise, eat less chocolate, persuade others of your viewpoint or make yourself more attractive to others, PsychCrunch is for you. From the British Psychological Society’s Research Digest, each episode is around 15-20 minutes long and features interviews with experts on different topics. The podcast is published quarterly and is presented by Dr Christian Jarrett, Ginny Smith and Ella Rhodes. It’s snappy, informative and evidence-based – an easy and engaging way to keep up with developments across psychology. Psychcrunch is available to download on Apple Podcasts, Stitcher and Spotify.

 

The Drop Out 

From ABC Audio, The Drop Out explores the story of Elizabeth Homes and her company, Theranos. Holmes’ goal was to create the first blood test which could provide multiple test results using only a drop of blood – the amount that would result from a pin-prick. This technology would make testing cheaper and more convenient and was widely described as ‘revolutionary’. Her idea drew enormous investment and made her the youngest self-made female billionaire. The only problem was that it was never more than an idea: Holmes’ company Theranos did not even manage to produce blood testing devices which were as accurate as machines already on the market, using the standard amount of blood required. For anyone working in healthcare, the story is an insight into the world of healthcare technology innovation: how it can happen, and where it can go wrong. From a psychological perspective, it considers the mind and motivations of someone dedicated to a goal, regardless of the situation and the cost. The Drop Out is available to download from Apple Podcasts, Google podcasts and Spotify. 

 

Where Should We Begin? With Esther Perel

Esther Perel is a Belgian-born couples therapist whose podcast episodes are unscripted, one-time counselling sessions. The names of the couples have been changed to help provide anonymity, but the voices and conversation are real. Perel now has a huge library of previous sessions, covering relationship challenges ranging from impotence too infidelity. Perel initially trained in psychodynamic therapy before training in family systems therapy. Her website states that she offers training in ‘psychodynamic, attachment, and systemic theories, as well as sex therapy, psychodrama, and body-oriented approaches’. In truth, as a UK-based, CBT-trained Clinical Psychologist, I’m not sure exactly what her approach is or how it is supposed to work, but it certainly makes for a good podcast. I’d recommend this show for anyone interested in relationships, the concept of one-time counselling sessions or the use of therapeutic models for couples therapy. From Audible, Where Should We Begin? can be downloaded from Spotify, Stitcher and Apple podcasts. 

 

I Hear Voices 

From BBC Radio 1, this podcast covers 27-year-old Alice’s experience of hearing voices. Alice has multiple voices, each of which has a different personality and may be more likely to occur in relation to different events that happen. For example, there is one set of voices that she only hears when she is cooking and another that occurs after she has self-harmed. Each episode is brief, lasting less than 10 minutes, and explains one of these voice-hearing personalities. The series is told entirely from Alice’s perspective and provides a window into what life is like when you hear voices which can be hard to ignore. Alice’s insight and perception into her own experiences are utterly illuminating for anyone working in mental health or psychology – highly recommended. I Hear Voices is available to download from BBC Sounds and Apple podcasts.

 

Bad Batch 

In the US, stem cells are big business. Touted as the cure-all for everything from joint aches to Parkinson’s, they can now be purchased in the form of non-controversial birth stem cells (taken from the umbilical cord blood of live born babies) and injected by medical professionals for just $5000 a pop. Bad Batch focuses on this industry, highlighting the lack of evidence to support the lofty claims made by stem cell distributors. It also highlights the risks, focusing on one company, Liveyon, which distributed stem cell vials which led to a group of treated patients falling gravely ill. They also happened to contain almost no active stem cells. Laura Beil, host and reporter, delivers some compelling insights into the factors which have enabled such an industry – and such a patient safety debacle – to occur. First, she highlights inadequate regulation of stem cells, as they are not treated as drugs by the Food and Drug Administration (FDA). Second, she highlights the nature of the profit-based US healthcare system, where treatments are marketed directly to patients using flashy advertising. For anyone interested in healthcare systems, it’s an engrossing insight into the problems that come when healthcare becomes a marketable commodity. From Wondery, Bad Batch is available to download from Spotify, Stitcher, Podtail and Apple podcasts.

 

The Last Days of August

Jon Ronson’s podcast, The Last Days of August investigates the death by suicide of porn star August Ames. Ames was aged just 23 at the time, and her death immediately followed a social media ‘pile on’ regarding a comment she made on Twitter. Ronson has long been interested in the effects of public shaming, and his investigation begins there. However, before long he moves away from viewing the Twitter storm as the main reason for Ames’ death. His investigation leads him to explore her childhood, adolescence, marriage to 43-year old porn producer, Kevin Moore and a recent traumatic film shoot she was involved in. As a Clinical Psychologist with a PhD in suicide research, I was a little frustrated that Ronson didn’t include any interviews with experts in suicide, which could have informed his investigation and provided a framework to put the puzzle pieces together. Despite this, it’s a deeply engaging podcast. Sensitively handled by Ronson and his producer Lina Misitzis, it had me gripped to the end. This podcast is likely to be of interest to anyone with a background in mental health or  suicide research. It suitably comes with a warning at the start of every episode though – listeners should be warned that it contains bad language and frequent sexual references, in addition to covering an extremely sensitive topic. From Audible, The Last Days of August is available to download from Stitcher, Apple podcasts, PlayerFM and Podbay.

 

The Shrink Next Door

From Bloomberg and Wondery, The Shrink Next Door tells the story of the relationship between Marty Markowitz and his therapist, Dr. Isaac Herschkopf. The story is told by long-time journalist Joe Nocera. Nocera had a house in the Hamptons and believed for years that the neighbouring house was owned by Herschkopf. He was invited to house parties by Herschkopf, who also happened to have his name on the mail box. Herschkopf was affluent enough to employ a handyman, whom Nocera regularly saw taking care of the pool and back garden when the Herschkopfs were not staying there. The first twist, of course, is that the house was never owned by Herschkopf: it was owned by Markowitz, who was also mistaken for being the handyman. The Shrink Next Door explores the progressively controlling, isolating and unhealthy ‘therapeutic relationship’ between Herschkopf and Markowitz which gradually saw Herschkopf taking control of Markowitz’s relationships, finances and business. As a mental health professional, this story made my jaw drop. I once agonised over whether it was appropriate to accept the gift of a DVD from a client who wanted to say ‘thank you’ at the end of therapy; the concept that a therapist could break every professional boundary going was utterly astounding to me. This podcast will interest anyone with a background in mental health or a concern for the oversight of therapeutic relationships in health systems. The Shrink Next Door is available to download from Stitcher, PlayerFM and Apple podcasts.

Four tips for building psychological resilience

Life is often stressful. These stresses can come in all shapes and sizes, from the burden of financial debt to the hassle of a fender-bender; from the heartache of a sick parent to the irritation of a late train. The bottom line is that whatever form it comes in, we can’t avoid stress. So what can we do about it? One obvious suggestion is to reduce the amount we’re exposed to: pay that bill a.s.a.p. and be careful to avoid other cars when parking in multi-storey car parks. This is good advice, but the reality is that not all stress can be avoided. For these types of stresses, it can help to increase our capacity to cope: our ‘psychological resilience’. But how can we do this? Here, I offer four tips based on research I have conducted into the factors that confer resilience.

1. Know your strengths: build your confidence. My research has shown that having high self-esteem helps people be resilient to stressful events. In a previous blog post, I outline one evidence-based technique for building self-esteem. Briefly, this works by encouraging you to consider your personal ‘strengths’ and then getting you to think of specific pieces of evidence which show that you have this strength. For example, if your strength is that you’re a good listener, a piece of evidence might be that a friend from work confided to you about their recent break-up last week. 

First though, you have to be willing to allow yourself to do this. When I deliver resilience training, many people I speak with are embarrassed to acknowledge the things they’re good at, for fear of appearing egotistical or narcissistic. This belief is both misleading and detrimental, as some individuals who are highly narcissistic in fact report low levels of underlying self-esteem. The reality is that knowing your strengths can help you to build a quiet confidence that will improve the way you work, and will not make you appear egotistical.

resilience

2. Learn to let yourself off the hook. Being a perfectionist is one of the worst things you can do for your mental health. It’s linked with higher levels of depression, anxiety and self-harm and it’s terrible for psychological resilience. What this tells us is that reducing our perfectionism could boost our psychological wellbeing and levels of resilience. There are misconceptions around perfectionism though, with people sometimes fearing that being less perfectionistic could make them less effective or high achieving. This isn’t the case. Perfectionism is about rigidity: it’s when people push themselves hard, no matter what. Being less perfectionistic involves self-awareness. It’s about knowing when to strive and push forward, and when to let yourself off the hook. If you’re a fitness enthusiast, this might involve knowing when it’s time to take a couple of days off training. If you’re a dedicated student, it might be knowing when it’s time take the afternoon off revision to see friends. For detailed suggestions on tackling perfectionism, see my previous blog post.

3. Focus on the future. When the present is no fun, it’s important to have things to look forward to, and research shows that having hope for the future can help us be more resilient. These don’t have to be big things, but they need to be clear in your mind. For example, you might enjoy going for a coffee and reading the paper, going for a walk in a park, or reading books. This practice is often incorporated into cognitive-behaviour therapy (CBT), and is called ‘pleasant event scheduling’. A recent study which tested the impact of pleasant event scheduling when done in isolation, without any of the other aspects of CBT, found it was effective in reducing risk of depressed mood. It’s not rocket science though – you can easily do this yourself by making a list of things you’d like to do and then scheduling these in your diary.

resilience

4. Don’t beat yourself up when things go wrong. There are three main ways that we explain negative events in our lives. First is how much we blame ourselves, compared with other people or the situation. Second is how permanent our explanations are: whether the problem that caused this one event is likely to keep on causing negative events in our future. Third is how all-encompassing are explanations are: whether this cause is going to make trouble in other areas of our life, as well. For example, if we were to fail an exam, we could think, “This is all down to my own general stupidity. I knew I’d never get through it”. This explanation is negative as we’re taking the blame entirely on ourselves. We’re also doing it in a permanent, all-encompassing way: if we’re stupid, it’s probably going to affect everything we do, forever.

The way we tend to explain events is habitual and it’s called ‘attributional style’. Resilient people explain events in a way that is more positive. In an exam failure situation, a resilient person would acknowledge any stress they’re under, or any other factors that could have affected their performance. Furthermore, they’ll do this in a way that doesn’t leak into other areas of their life and gives them hope for the future. In this example, a resilient person might think, “It was a stressful time with my mum being ill. I haven’t had to manage this kind of situation before, and the result was that I didn’t allow enough time to revise. I’ve learned for the future though: I know what I’ll do differently next time”. Not only will this person feel less bad about the exam failure, they’re also more likely to pass next time. It’s possible to change the way that you explain events with cognitive-behaviour therapy. For a do-it-yourself approach to improving your attributional style, I’d encourage you to ask yourself three questions when you know you’re beating yourself up about something:

  1. What range of factors contributed to this event? When things go wrong, they can rarely be pinned on just one thing. List all the things you know contributed to the event, to help yourself create a balanced perspective.
  2. What else has gone right recently? Think about other things that went to plan, no matter how small. This might be, for example, a friend’s birthday that you remembered, a work task that you completed well or a tricky conversation that you handled sensitively. It’s important to remember that this negative event doesn’t define you.
  3. What can you do to reduce the chance that a similar event will occur in future? Think about anything you’ve learned from this. Think about any actions you can take, whether this is personal (e.g., allowing more revision time in future) or external (e.g., asking for input from a tutor).

With all of these tips, it’s important to know that having good relationships with friends or family can help. Talking to others about stress you’re experiencing can help you to realise when it’s time to take action and can help you to change your perspective. Have you ever moaned to a friend about a rough day at work, and appreciated it when they pointed out that it wasn’t all your fault? Well, that’s an example of them helping you to develop a more positive attributional style for that event. The take home message is: talk about it! It’s easier than trying to do it alone.

This article was originally posted on the Psychreg website on 14 June 2019.

Ten tips for aspiring Clinical Psychologists

The competition to become a Clinical Psychologist is fierce. In the UK, the constituent parts of the training are a three-year undergraduate degree which is accredited by the British Psychological Society (BPS), and a three-year taught Clinical Psychology doctorate. The doctorate is full-time; candidates are employed by the NHS and complete a series of six-month placements in addition to coursework and a research project.

Psychology undergraduate students self-fund their degrees and as such, courses have flexibility about the number of students they can enrol. Psychology is consistently the second most popular degree in the UK, with an estimated 13,000 graduating each year. However, until recently, the only places offered on the doctorate were NHS funded, and therefore carefully regulated. Between 2012 and 2018, doctorate courses enrolled around 590 students per year altogether; just 15% of the total number of applicants. While three courses now include self-funded places, these come with a price tag of £20k+ a year, putting them out of reach of most graduates. 

Here, I offer 10 tips for aspiring Clinical Psychologists:

1. Know the bottom-lineIf you are at the point of applying for the doctorate, look at the particular courses you are interested in on the Clearing House website. What are their non-negotiables? Many courses now stipulate that candidates must have a 2:1 or a score above 65% in their undergraduate degree. Others require that applicants have a year’s clinical experience supervised by a qualified psychological therapist. If you don’t meet their stipulations your application will be automatically excluded, even if it is otherwise strong.  It is therefore worth researching each course’s bottom-lines before you apply.

2. Look into placement-year degrees. Several universities including Aston, Bath and Leeds (where I am based) offer applicants the opportunity to undertake a placement year ‘in industry’ between the second and third year. This means that students can gain relevant clinical experiences which can help them to be competitive applicants for graduate jobs. These placements are overseen by the universities, helping to ensure that they provide students with more useful experiences than they may gain through general volunteering. Some placements also offer a contribution towards expenses or a stipend, which volunteer roles generally do not. 

3. Consider the ‘Increasing Access to Psychological Therapies’ (IAPT) initiative for an alternative career as a psychological therapist. IAPT was launched in 2007 to provide greater access to psychological interventions for people with mild-to-moderate anxiety and depression. It is now planned to expand in order to provide therapies to 1.5million adults per year by 2020/2021. There are two main types of psychological therapists working in IAPT: Psychological Wellbeing Practitioners (PWPs) and High-Intensity CBT Therapists (HITs). PWPs are recruited into training positions with IAPT services on an NHS band 4; once they are qualified, they are paid at band 5 and can progress to band 6 (for information on NHS pay bands, see here). Similarly, HITs apply to train with specific NHS services. They train on band 6 and are paid on band 7 once qualified. Sign up to NHS jobs for alerts about these roles. A follow-up of HITs suggested that 79% stay in IAPT services after qualifying, 61% become CBT supervisors and 23% progress to more senior roles. It also possible to self-fund training to qualify as a CBT therapist, by undertaking a postgraduate course accredited as Level-2 by the British Association for Behavioural and Cognitive Psychotherapies (BABCP). 

4. “Remember at the end of the day, it’s just a job”. This was the best advice I was given before I attended my interviews for the Clinical Psychology Doctorate. A qualified Clinical Psychologist called me to give me some advice, and these words helped remind me that I wasn’t auditioning for the X-Factor: at absolute best, I would become a qualified psychological therapist. Imminent fame, stardom and riches were not around the corner. Being a Clinical Psychologist in the NHS is a wonderful job, but it is not without stress and strain, like any other healthcare related job. So, relax: it’s just a job.

5. Vary your experiences. Working as a research assistant or assistant psychologist will give you great experience for the Clinical Psychology doctorate, but more than a year in any one post will have diminishing returns. While you will always need to balance the opportunity to gain varied experience with the need to pay your rent and bills, it’s worth remembering that having a broad skillset will give you the strongest CV and application.

6. Treat applications like assignments and interviews like exams. You cannot assume that the knowledge and experience you have will naturally shine through: work hard to sell yourself. Consider carefully the range of experiences you have had. For example, what is the range of client groups you have worked with? What experiences have you gathered? Think carefully about the knowledge you have in relation to engaging different client groups, conducting assessments, collecting and storing sensitive data, managing risk, and applying psychological theory to individuals, for example by contributing to formulations or interventions. Also consider carefully the job which you are applying or interviewing for: who is interviewing you, and what is their area of interest? Which client group will you be working with, and what things might you need to be conscious of? Which therapeutic modalities might you be using, such as CBT or psychodynamic approaches? One way to impress your interviewers is to appear prepared for the opportunity they are offering. For more tips on improving your chances of being successful in your applications for assistant psychologist posts, see my more recent blog post here.

7. Consider alternative psychology disciplines. If you have a BPS-accredited undergraduate degree, Clinical Psychology is not your only option for working therapeutically. For example, many posts which are open to Clinical Psychologists are also open to Counselling Psychologists. To train as a Counselling Psychologist, you can either do a self-funded doctorate degree or the BPS qualification in counselling psychology; this involves three years of supervised practice. More information is available here. Alternatively, for psychologists interested in working with forensic populations, Forensic Psychology may offer a fulfilling alternative career to Clinical Psychology. In some secure hospitals, much of the work of Forensic Psychologists involves delivering psychological therapy. To train as a Forensic Psychologist you can either complete a Doctorate in Forensic Psychology or a Masters in Forensic Psychology followed by two years of BPS training and supervised practice. More information on becoming a Forensic Psychologist is available here. It is also worth noting that the University of Birmingham now runs a four-year doctorate which offers candidates a dual qualification in both Forensic and Clinical Psychology (see here). 

8. Look for research opportunities. As an undergraduate I undertook some voluntary work as a research assistant with a professor and lecturer in my department. It was one of the best decisions I made: it paved the way to my Medical Research Council-funded PhD in Resilience to Suicidality and kick-started my love of improvement in healthcare. It also helped me to gather a range of experiences in working with clinical populations, as my PhD involved undertaking psychological assessments with people with psychosis and testing a novel mood-boosting intervention in this group. I would highly recommend seeking research opportunities to aspiring Clinical Psychologists. If you are currently a psychology undergraduate, seek opportunities with clinically-oriented researchers in your department. If you are a psychology graduate, sign up for job alerts at jobs.ac.uk and look for opportunities which would allow you to gain experience working with clinical psychologists and/or researching with clinical populations.

9. Keep your eye on the proposed role for ‘Clinical Associate Psychologists’. This is anticipated to take the form of an apprenticeship which will last 18 months and produce psychology professionals who undertake psychological assessment and formulation, and who deliver psychological interventions. At the moment, it is suggested that each Clinical Associate Psychologist will train on a Band 5 salary and be paid at Band 6 once qualified. The plans are currently in development, but should be in place in the coming year. 

10. Take heart: the need for psychologists is not diminishing. While the sense of competition may feel overwhelming, the demand for psychological therapies is increasing, which is reflected in the introduction of the IAPT initiative and the new role of the Clinical Associate Psychologist. While getting a place on the Clinical Psychology Doctorate may be challenging, if you have a passion for psychological work, the future is bright!

Finally, I want to note that while the cap on funded places for the Clinical Psychology doctorate produces a low success rate at the point of enrolment, I believe it also offers significant benefits. First, the competition that the cap creates means that aspiring Clinical Psychologists need to seek additional experience and training after their undergraduate degrees to strengthen their applications. This experience ensures that all doctoral trainees know the discipline they are working in and can feel confident in their career choice before they sign-up to the three-year course. This is reflected in the high retention rates of courses (99.4%): students rarely fail to complete their doctorate, once they’re on it. Second, it means that once qualified, Clinical Psychologists have good job prospects: 95% are employed in a clinical psychology job within 12 months of graduating. Deregulating the number of doctorate training places could shift this balance, creating the possibility that qualified Clinical Psychologists could become unable to find employment. By ensuring that applicants are experienced and committed, I believe that continuing to fund all forms of postgraduate psychological training offers the best outcome for applicants, healthcare providers and clients.

Reflective practice groups for liaison psychiatry nurses: are they helpful? Our study

Liaison psychiatry nurses have a tough job. They are based in the Emergency Department and work with individuals experiencing acute distress; these patients may have recently self-harmed or attempted suicide and could be at high risk of further harm. Liaison psychiatry nurses contact gatekeepers to other services while under the pressure of national waiting-time targets. They usually have no continuity with patients after they are discharged and may be left wondering how their patients’ situations turned out in the end. Both mental healthcare staff and emergency department staff are high risk groups for burnout (Johnson et al., 2018; Potter, 2006); liaison psychiatry nursing combines each of these elements and so these nurses may experience particularly elevated stress.

In order to provide liaison psychiatry nurses with more support, one hospital introduced reflective practice groups. The groups were a protected hour: the liaison psychiatry nursing team left the department to go to a quiet room in another building where they could not be contacted. The groups were facilitated by a clinical psychologist already employed by the hospital. I particularly liked this feature; too often I hear about outside consultants being paid hefty sums to deliver wellbeing packages with hazy evidence bases, when most healthcare organisations already have a group of highly trained professionals employed in their  psychology department who can do this work. The psychologist enabled dialogue between the team members and facilitated their conversation but did not impose an agenda.

When I was invited to contribute to the evaluation of this intervention I was delighted. We interviewed 13 liaison psychiatry nurses who had attended the group. They identified four main benefits of participating:

  • Sharing and learning. Participants found that sharing their experiences in the group helped them to feel less alone. They realised that other people in their team were experiencing similar challenges and they left the group sessions feeling clearer-minded and lighter.
  • Grounding and perspective. Participants said the group allowed them to take a step back and gain perspective on the difficulties of their work and the risks involved. It reminded them of the value their work has.
  • Space. Participants described the group as a safe space; they felt able to ask for help or to say they were unsure of things and seek advice from their colleagues.
  • Relationships. Participants said the group supported some positive interpersonal experiences between team members. The fact that they had an external facilitator and were guaranteed to be free from interruptions led them to feel they could raise difficult issues with their colleagues, in the knowledge they would be able to resolve these before the conversation ended.

It should be noted that not all nurses found the group beneficial. Some felt that the types of discussions they had during reflective practice were already happening elsewhere and they believed a protected space was not necessary. However, these nurses recognised that some of their colleagues benefited from the group, and were willing to participate in recognition of the overall team benefit.

We weren’t able to quantitatively evaluate the group as the number of participants in the study was too small. However, our qualitative data suggested that overall these groups provided a range of benefits which would have been hard to get from another forum, and some participants believed that sickness absence in the team would have been higher without them.

Practical tips for running reflective practice groups

For anyone wanting to run reflective practice groups, our study suggested a few things should be considered:

  • Groups shouldn’t include managers. The presence of managers changed the nature of the group and inhibited open discussion.
  • Protected time is key. Nurses stated that the groups were the only time they were guaranteed to have a conversation at work without interruption, and this was an absolute necessity for helping them feel able to discuss sensitive issues.
  • The facilitator must be external to the group. Previous research suggests nurses trained in reflective practice can supervise these groups and there can be benefits to having someone of the same discipline provide this facilitation. However, experienced clinical psychologists should be sufficiently trained to offer this in the absence of trained nurses. Our study suggests this is acceptable to nurses and the important thing is that the facilitator works in healthcare but is external to their team.

A practical and cost-effective solution

Further research is needed to establish the effectiveness of reflective practice groups for supporting staff wellbeing. However, the evidence base for burnout reduction interventions in general is still small (see my previous blog on this here), and the best methods for supporting staff are not yet established.  While we wait for evidence-based recommendations, reflective practice groups are a cost-effective form of support for liaison psychiatry nurses: they require no special equipment, no long periods of staff absence from work and can be facilitated by in-house psychologists, so no expensive outside consultants are required.

To read this study please see here