You don't have to have all the answers
Dr Hannah Alghali on what she learnt working as a clinical psychologist who doesn’t work in a clinic.
08 January 2020
For my third-year placement as a trainee clinical psychologist, I wanted to do something different. I’d begun to find working in a clinic setting a bit repetitive, and the potential impact of this work felt limited. I had also begun to feel that while individual therapy might work for some, there was a whole section of the population, often young and black, who weren’t able to access the support that was offered. I’d noticed that traditional mental health services often failed to tackle the structural and systemic challenges which contribute to young peoples’ distress. In addition, I’d conducted a research project which found that black service users often felt alienated from mental health services, feeling that they were designed with different needs in mind. As a result, I wanted to explore how psychologists could better support the needs of marginalised young people.
So, I decided to venture out of the clinic. My third-year placement was based in various settings across London, supporting young people who had been affected by serious youth violence and exploitation. I worked in a psychologically informed co-produced wellbeing service, based on the integrate model (Durcan et al., 2017). It was a bit like a youth club, with a TV, PlayStation and ping-pong, staffed by psychologists and youth workers. The service aimed to provide young people with holistic support, helping them with driving licences and work applications, as well as providing support for their mental health.
Staff drew upon attachment theory, mentalisation based approaches, and narrative theory, while taking a community psychology stance, which acknowledges how societal disadvantage and structural barriers impact on wellbeing and contribute to distress. Using a peer-to-peer referral model, young people who accessed the service built trusting relationships with staff and brought their friends along to access the support that they themselves had found helpful. I also provided individual therapy in the form of psychologically informed conversations in places young people felt safe, including parks, a McDonald’s and a bench on a busy high street.
Here’s a few things I’ve learnt on my journey applying community psychology to my work alongside young people affected by serious youth violence.
You have to re-learn what you know
Throughout my first two years of clinical training, I’d learnt about different models of therapy. I’d learnt CBT protocols and mindfulness techniques. I’d learnt the common symptoms of depression, and how to set an agenda. But when I started on my community psychology placement, I had to unlearn some of the techniques that had been so helpful in a clinic setting. Instead, I learnt the need to be flexible, to think on my feet and adapt what I knew to a very different setting. Thought challenging with a seven-column-form became a debate around consent with young people sitting on a bench in the sunshine. Narrative therapy became helping a young person write their CV. Safety planning became a conversation over a Nando’s. And sometimes it was about just hanging out with young people until they trust you enough to ask for help.
Sharing power is really important, and really difficult
Much of the work in a community setting involves working alongside young people who haven’t had professional training. What they do have is tonnes of creativity, enthusiasm, ideas, and the experience of living through many of the problems and challenges community psychologists are trying to solve. What they also have is the all too common experience of being disempowered and disregarded by professionals and organisations. It felt really important to try and readdress this power balance, and make sure the voices of young people are privileged in team meetings and when interacting with other professionals. However, I found it can be really difficult to empower others when you yourself feel a bit lost and confused in the jump from the clinic to the community. I haven’t found an easily solution, but I think sharing some of these challenges with the young people you’re working with, as well as in supervision, can be really helpful.
I will never be very good at Fifa
Unfortunately, they don’t asses your Fifa skills as a prerequisite for getting on to clinical training. So when I sat down in front of the TV and one of the young people handed me a controller, my heart sank a little. I had a go, got thrashed 6-0, and had to endure quite a lot of teasing. But I learnt that by hanging out by the TV, and asking for help in learning which button is pass and which is shoot, I was able to engage young people who often have little trust in professionals and services. I don’t think it matters too much that they always beat me… in fact it probably helps, given the traditional power imbalance. Some of the best conversations I have had have happened around the TV, and although I rarely get handed the controller any more, the young people always seem happy for me to pull up a chair and ask them how they are while they kick balls across the screen.
It matters to young people that you have brown skin
Clinical psychologists are mostly white. Throughout my training, I’ve worked with the widening access scheme to try and increase the number of clinical psychologists from minority ethnic backgrounds. But I don’t think I quite realised how important it is for psychologists to represent the service users they serve until I began my community psychology placements.
On my first day, two young people called me to join them outside. ‘So, where are you from?’, they asked me. I had a split second to think back to my teaching on self-disclosure and boundaries, before deciding to answer truthfully in an attempt to build trust. They smiled and told me they were from Bangladesh. That was one of the first of many conversations about race and identity, from how internalised racism impacts self-esteem to a frank discussion about how police discrimination exacerbates feelings of paranoia. I’m not saying that white psychologists can’t have these conversations with young people. But my presence brought race in to the room, and I think that has been invaluable.
You don’t have all the answers. And that’s how it should be.
When you’re trying to impress your new supervisor and new team, it can be hard to realise that not knowing the answer is often much more helpful than knowing it. Community psychologists want to draw on the knowledge and strengths in communities. They want to ask young people for help, and they want to co-produce solutions with them. So I quickly learnt that if you think you know the answer, you’re way off the mark. It’s important to be curious and hold lots of different perspectives and ideas in mind. Although this can be a scary position to take, trust me, you’ll learn much more than you thought you needed to know.
Reference
Durcan, G., Zlotowitz, S., & Stubbs, J. (2017) Meeting us where we're at: learning from INTEGRATE's work with excluded young people. Centre for Mental Health.
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