Back to clinical work after a year away - suggestions?

[temppsych123]

Background: I am starting internship soon at a very research-focused AMC, and I plan to look for academic/research positions after postdoc. I've always been primarily research-focused, although I had more than enough F2F clinical hours to be competitive for internship. Because of a whole host of life circumstances and research priorities, I didn't do a clinical placement this past year; when I start internship, it will be over a year since I saw my last client (and that most recent placement was part-time).

As start day approaches, I'm getting more and more nervous about how long it's been since I've seen clients, and I'm wondering how much prep work I should be doing to get "back in the saddle" so to speak. Has anyone else had a similar experience? How hard did you find it to transition back into clinical work? Any recommendations? I am primarily trained in CBT working with adolescents and adults.

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[erg923]

Skill based stuff wasn't an issue for me after a had a been in academia/teaching for year. The pace of full time clinical work was a bit difficult adjust too, however.

 

[temppsych123]

Skill based stuff wasn't an issue for me after a had a been in academia/teaching for year. The pace of full time clinical work was a bit difficult adjust too, however.

Yes, I could definitely see that. I've done close-to-full-time placements before (4 days/week full-time clinical, 1 day/week research from home) and found it exhausting, but also helpful for me personally to have a schedule and concrete things to do each day (versus the very free form schedule I've had this past year working on research projects). So I'm hoping that part won't be too terrible (although the waking-up-for-hospital-schedules thing is probably going to suck...bring on the caffeine!).

 

[erg923]

I was not used to having to be "at work" at very specific time either. Which has always sucked. Sonetimes I have **** to do in the morning times, right?

 

[Therapist4Chnge]

By far the hardest part was having a required scheduled 8:00am-4:30pm (typical VA, though report writing was typically later), followed by having one day a week of solid out-pt therapy. Even doing manual used treatment for it was a grind bc while I had previously completed therapy practice so, the volume was less and split up over a couple of days a week.

We did a day a week per rotation (for the year), so I had a buffer of other rotations on the other days; I don't think this is typical for internship. Doing therapy every day for 3-6-however many months would have sucked....hard.

 

[deleted343839]

I didn't do any clinical work during my last year in residence either, and I agree with others that the hard part was getting used to the structure/schedule of internship. After the first month I didn't feel "rusty" clinically. I can't say I ever got used to the 10-hour days though.

 

[smalltownpsych]

I had an almost two-year gap between internship and postdoc. For me it was just like riding a bicycle, once the patient was sitting across from me it all came back. Definitely wasn't like my first practicum experiences where I was really flying sort of blind.

Internal dialogue from then:
"Okay, patient said they are thinking of suicide. What do I do now? Let's see...risk assessment, safety plan..am I missing anything? Am I minimizing or am I over-reacting? Should I break confidentiality by notifying their family member? How do I go about committing patient if they do need it? Figures that my clinical supervisor isn't available right now. Where did I put their number? I hope I don't get their voice mail."
All of this and more while trying to remain focused and engaged with a patient in clear distress.

Even with the two year gap, I sure as heck didn't feel that helpless and the nice thing about postdoc is you are still getting supervision so still have a bit of a backstop.

 

[temppsych123]

Thanks for the encouragement everyone!