'Part of my role is to inspire hope'
I’m a recovery worker in a Personality Disorder service; I’ve been doing it for a year-and-a-half now. People with a personality disorder diagnosis are likely to have received the message that recovery isn’t possible, and they may have felt a loss of control and sense of hopelessness that comes with that. Part of my role is to inspire hope, working alongside and encouraging autonomy in our service-users.
We empower service-users to see their journey as one of discovery – as many people with these experiences say there is not a version of themselves to recover back to. We focus on using community groups to build identity, finding out what works for service-users and putting their own skills and knowledge into practice outside of the service.
Into the role
Even though I have a background of studying Psychology and Clinical Psychology at undergraduate and master’s level, I was pretty late to join the working world of Psychology. Once I’d finished my masters, I had a baby and got a bit lost in a part-time working role that wasn’t anything to do with mental health. When my son reached an age where he could go to nursery, I knew it was time for me to get back into a career path that I had worked towards during my university days.
I panicked a little at how I might get a role in such a competitive environment when I had no practical experience, but I began interviewing and looking for volunteer opportunities hoping something would work out… and it did. When I got the interview for a dedicated personality disorder service with part-time hours, I thought it was too good to be true. I was particularly passionate about personality disorder due to a relative’s lived experience with this diagnosis, and the part-time hours would work around my childcare. My luck was in: I got the job!
The service I work for is all group-based, and uses a 2-to-1 method for any individual support sessions, due to the client group and potential attachment difficulties. We work from community centre hubs across three localities (pre-Covid, at least). Our team is made-up of the clinical team, who work for Sussex Partnership NHS Trust, and a community team of which I am part of. My main responsibilities are creating and facilitating groups and supporting service-users in 2-to-1 meetings, which has given me direct clinical experience of working with people in distress. I’m also on hand to assist the clinical team with clinical work. That’s a real perk of the job when you’re an aspiring clinical psychologist.
Whilst we have a structure and timetable that we stick to each week, we also have daily challenges and dilemmas that keep us on our toes! Community groups can range from arts and crafts, music appreciation, creative writing to cooking and baking. What I like about our service is that our team and the service-users work collaboratively to come up with new ideas for activities to do in these spaces. One of the most fun afternoons we’ve had involved a group science experiment in which we created and decorated a volcano, then used some science to make the volcano erupt.
Activities like these are vital in our service as we like to provide our client group with an opportunity to access the playful side of themselves, which has often not been allowed to develop in their childhood. One of my service’s values, and part of my role as recovery advisor, is co-production –working with our service-users to develop and improve the service. This has given me insight into community psychology approaches as well as seeing more traditional clinical psychology in the evidence-based therapy groups that we run. Clinical groups range from Schema Therapy, to DBT skills or a Service User Network (SUN) style support group.
I’m really grateful for the clinical groups I’m able to take part in. Every day I am able to learn something beneficial about applying psychology in practice, to take forward in a career of clinical psychology. For example, joining our psychotherapist and occupational therapist in co-facilitating our Schema Therapy group programme over the space of a year has been so rewarding, and I now feel much more confident at formulating and understanding our service-users.
Making a difference
The best thing about my role comes down to the motivation I assume many of us have for choosing psychology as a career path – wanting to ‘Make a difference’. I know it could be considered a vague phrase that lends itself to clichés, but to me it’s measurable by the feedback we get directly from our service-users. There are moments, for example when completing Schema Therapy, where a client is invited to feedback about their journey in our service. You can’t deny the sincerity in their eyes and the authenticity in their voice when they credit our service, the staff, their peers and therapy as the reason they are alive today. There is no moment more moving or rewarding for me, as a professional, and it’s what inspires me to continue my journey in this career path. If every day, I’m able to contribute in some way towards making that kind of impact on someone’s life, I’ll be happy.
A more challenging part about this role is that we are working with people who have often be let down and abused by the people who were supposed to care for them, and this can affect how able they are to build trust and feel safe with us as professional caregivers. We often have service-users who struggle to engage and avoid or push against us and the boundaries of the service. When your resilience is high, these scenarios feel easier to manage, but sometimes it can feel particularly stressful and you can notice counter-transference in yourself, where you’re holding the anxiety or pressure that has originally come from the service-users. I need to be aware of not immediately overcompensating to relieve this feeling that I’m not doing enough. I’ve come to learn that using reflective spaces to identify where counter-transference is affecting me stops it from snowballing and leading to burnout.
Keeping a sense of community
Our current challenges are pretty obvious. As a team we had to take a group-based service that relied on the feel of community and make it work online! Like most other services, we have had to adapt our model to work post-Covid. Initially, we reacted by offering weekly support calls to our 75 service-users. However, by April 2020 we were able to get an online group offering up and running, which was much more compatible with our group-based model, thanks to our team’s creative thinking and hard work.
To address the sense of community which originally felt lost when we were unable to be together in person, I began creating a weekly newsletter to send out via email every Friday to all members of the service. We have found this has been an important resource for keeping members engaged and feeling like part of the service. When the principal psychologist in our service undertook an audit that looked at service-users’ engagement post-covid, the newsletter was often cited as an important resource in helping them feel engaged when they were unable to attend groups. It has been rewarding to hear this feedback, and has inspired me to keep going – I’m fast approaching the 52nd issue!
Many of my service-users still report facing stigma from both friends and family and professionals alike. An alarmingly high number of service-users that I have worked with over the past year and a half have spoken about feeling invalidated and dismissed by people using phrases like ‘manipulative’ ‘difficult’ or ‘attention seeking’ when they are in crisis. Whilst we have made a lot of progress in this area, and our service-users are noticing that, I hope to get to the stage where no-one with complex mental health is made to feel invalidated or misunderstood due to stigma.
One way we can combat this is providing training into the diagnosis and helping others to understand what’s happening for people with personality disorder when they’re in distress. This is something I’ve been really grateful to have the opportunity to take part in delivering myself over the last year. Alongside clinical psychologists and experts by experience, I have been able to co-facilitate personality disorder training online which aims to provide a range of professionals, from support workers to psychiatrists, with a better understanding of the diagnosis. The goal of the training is to aid professionals in working using trauma informed care, which in turn should improve service-users’ experiences.
Training and support
I’d also like to see an increase in local training opportunities for aspiring clinical psychologists like myself. The assessment and treatment services in my area are currently struggling to recruit for band 7 and 8a psychology posts, even though there are so many motivated people like myself who would love the opportunity to train for and fill these roles.
I would also value support from psychologists to apply psychological theory in practice. It has been really stimulating to apply attachment theory and schema therapy day-to-day in our psychologically informed environment, and I would like to learn from other psychologists who use different theoretical approaches to aid their work and research. For example, I’ve been putting together a self-care workshop that aims to support our service-users with a basic psychological understanding of trauma and why certain types of self-care are impactful and how they change our physiology. I had input from our principal clinical psychologist, who directed me towards Polyvagal Theory, which I researched and used to inform the workshop – breaking the theory down into an accessible and digestible format for service-users.
I can’t know what the future holds for me, but at the moment it’s so rewarding to hold this role and have an opportunity to inspire self-discovery and hope in service-users for their own fulfilling future.
- Jess Rose is a Recovery Advisor with Thinking Well, Personality Disorder Service, Eastbourne. [email protected]
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