Social Awkwardness in Clinical Psychology

[AwesomeAutist]

Hi all, and thank you in advance for your input!

The situation:
I am an Army veteran and working nurse (BSN).

The problem:
I am socially awkward, and the opinion of more than one psychologist I have consulted is that I am a high-functioning member of the autism spectrum.

The question:
Can a person who is very socially awkward succeed in clinical psychology or are they setting themselves up for failure? If refined people skills ('schmoozing'/networking) aren't critical for patient interaction or teaching (which I understand the meat of clinical psychology to be), are they critically important in other ways that would torpedo my career at a later point?

The details:

From my work history, you can probably guess that I can tolerate social interaction and teach my coworkers to tolerate me. On the other hand, working as a soldier and later going through nursing school and now working as a nurse was/is extremely challenging. I feel like the amount of stimuli I experience in rushed patient interaction is taking years off of my life, even if it is something that I value highly.

However, I have never had a problem with one-on-one interactions--on the contrary, I relish it. It's something that genuinely makes me happy to be privy to someone's most trying times and inner thoughts, and the people that I have talked to have said it is something I'm good at. I suspect this is partly because my interlocutor is receiving my 100% attention, and I clearly value the chance to have this interaction highly because--frankly--I don't have a superabundance of acquaintances to talk to.

I am asking this because I would very much like to stop this habit of mine--jumping from the frying pan into the fire (e.g., from Army to nursing school to bedside nursing)--and I wanted to see if the professionals and students working on this forum could offer any insight. Thank you.

[If it matters, my quantitative skills, GPA, and research are completely 'there' for many PhD/PsD programs--I double majored in Psych.]

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[Pragma]

Most of us are awkward in some ways. Academia is full of social awkwardness.

 

[voyeurofthemind]

Maybe as a academic clinic psych might be an ok fit. I can't really imagine you would enjoy doing any sort of clinical work unfortunately if it feels like you have to "tolerate" social interaction.

 

[Rivi]

You can always plan on going into academia and research, or if you wanted to do clinical work, you could focus on assessment (neuropsych, school psych, forensic, etc.). You would probably not have as many problems with structured interviews, but therapy can throw you a lot of curve ball situations where you have to think on your feet. Groups would be especially challenging. Most programs give you some flexibility in which training sites that you go to, so that is good news too.

 

[AwesomeAutist]

Most of us are awkward in some ways. Academia is full of social awkwardness.

This is very encouraging, thank you.

 

[AwesomeAutist]

Maybe as a academic clinic psych might be an ok fit. I can't really imagine you would enjoy doing any sort of clinical work unfortunately if it feels like you have to "tolerate" social interaction.

"However, I have never had a problem with one-on-one interactions--on the contrary, I relish it."

Just wanted to make sure this point was emphasized... I am really not bad in one-on-one conversations, especially when it is a focused discussion or where I have a professional role. Small talk completely eludes me, but--from what I can tell, anyway--leading therapy would not be a problem for me.

Small, intimate groups where I have a defined, professional role aren't something I am particularly concerned about, either.

I just wonder what I'm *not seeing* that would be a problem for someone who is horrible at small talk, awkward, occasionally lacks affect, and who is susceptible to overstimulation.

 

[AwesomeAutist]

You can always plan on going into academia and research, or if you wanted to do clinical work, you could focus on assessment (neuropsych, school psych, forensic, etc.). You would probably not have as many problems with structured interviews, but therapy can throw you a lot of curve ball situations where you have to think on your feet. Groups would be especially challenging. Most programs give you some flexibility in which training sites that you go to, so that is good news too.

That is also very encouraging, thank you.

There are very few positions where someone in my shoes can both succeed and flourish, and I am elated that psychology (ironically) seems to potentially be one of them!

 

[Meteora]

If I was rich and had my own line of designer cologne, it would be called "Le Awkwaux."

But seriously, I think part of it depends on which career specifically you want to do. In research, I don't think being on the spectrum would affect you much. If you want to be a therapist, I'm not 100% sure as it's possible that your own awkwardness/discomfort might interfere with your ability to provide what's best for your clients. But even then, I'm not sure. Socializing is certainly a muscle to be exercised, regardless of whether you're on the spectrum or not. It's something that you can get better in with exposure and practice. This is definitely something to discuss with any faculty in psychology you know; ideally faculty that KNOW you pretty well and could give guided advice.

As Pragma phrased it, most of us are awkward to some degree. It's not necessarily something that is permanent and people can certainly grow with the passage of time and accumulation of experience.

 

[bmedclinic]

Most of us are awkward in some ways. Academia is full of social awkwardness.

This is pretty much my perspective, OP.
If you're high functioning and a little awkward, you'll probably fit right in-- and-- such training will likely be a good growth opportunity. No one enters clinical training ready to go, everyone needs that growth.

 

[deleted343839]

However, I have never had a problem with one-on-one interactions--on the contrary, I relish it. It's something that genuinely makes me happy to be privy to someone's most trying times and inner thoughts, and the people that I have talked to have said it is something I'm good at. I suspect this is partly because my interlocutor is receiving my 100% attention, and I clearly value the chance to have this interaction highly because--frankly--I don't have a superabundance of acquaintances to talk to.

Something else to consider is how well you read others' nonverbal signals. Subtleties of speech, facial expression, and posture can provide valuable information. If you find yourself taking others' words at face value or frequently misunderstanding others' intent, this might present a challenge for you. That's not to say that you can't learn to be more attuned to those signals, though. And if you choose your area of specialty carefully, this may be less of a concern.

For the most part, the pace of a psychology practice is very different from nursing, and probably less exhausting from a social interaction perspective.

 

[smalltownpsych]

Some other points to think about. Patients want someone that helps them feel comfortable. Developing rapport quickly and easily is an essential skill. I am able to do that with most people and thus my practice is full. It has been my experience that the more socially awkward a psychologist is the more limited they are in their ability to get patients to come back for more sessions. Also, certain populations or diagnoses might be more amenable or resistant to a socially awkward therapist. Kids don't care, but parents might. Substance abusers have been the worst for socially awkward people to deal with in my observations. Patients with borderline personality disorder could be more challenging as they often excel at reading the emotions and non-verbals of others. Patients with OCD and patients who are more socially awkward themselves, based on my own limited observation, can do quite well with a socially awkward therapist.

 

[AwesomeAutist]

Something else to consider is how well you read others' nonverbal signals. Subtleties of speech, facial expression, and posture can provide valuable information. If you find yourself taking others' words at face value or frequently misunderstanding others' intent, this might present a challenge for you. That's not to say that you can't learn to be more attuned to those signals, though. And if you choose your area of specialty carefully, this may be less of a concern.

For the most part, the pace of a psychology practice is very different from nursing, and probably less exhausting from a social interaction perspective.

This was somewhat of a concern for me, thank you for touching on it. Part of my experience with ASD (or perhaps just my personality) is that I can be completely oblivious to "duh!" common sense nonverbal cues, but on the other hand I have become particularly attuned to analyzing a person's appearance or actions--to the point where I'm told I'm reading into something too much... but then it turns out that my intuition was correct.

What specialties would you think this would be less of a concern?

 

[AwesomeAutist]

Some other points to think about. Patients want someone that helps them feel comfortable. Developing rapport quickly and easily is an essential skill. I am able to do that with most people and thus my practice is full. It has been my experience that the more socially awkward a psychologist is the more limited they are in their ability to get patients to come back for more sessions. Also, certain populations or diagnoses might be more amenable or resistant to a socially awkward therapist. Kids don't care, but parents might. Substance abusers have been the worst for socially awkward people to deal with in my observations. Patients with borderline personality disorder could be more challenging as they often excel at reading the emotions and non-verbals of others. Patients with OCD and patients who are more socially awkward themselves, based on my own limited observation, can do quite well with a socially awkward therapist.

That's very interesting... What about a therapist who was more of a quiet, listener-type?

Therapy hasn't been a big part of my life, but I have seen a handful of therapists at different points for random things--the majority (not trying to cause offense with this to anyone reading) were kind of chatty-cathy, touchy-feely types. To the extent that, in retrospect, they might have missed their vocation in bedside nursing. If I were inclined to continue therapy with them, I probably wouldn't have wanted to return to someone who made me feel like I'm talking to one of my wife's gossip-y soccer mom friends--again, no offense to gossip-y soccer moms.

Is there no advantage in therapy for a more taciturn, studious (male--I understand we're now a minority in the profession) therapist?

 

[AwesomeAutist]

"The problem:
I am socially awkward, and the opinion of more than one psychologist I have consulted is that I am a high-functioning member of the autism spectrum.

The question:
Can a person who is very socially awkward succeed in clinical psychology or are they setting themselves up for failure? If refined people skills ('schmoozing'/networking) aren't critical for patient interaction or teaching (which I understand the meat of clinical psychology to be), are they critically important in other ways that would torpedo my career at a later point?"

I've been accused of this before (asperger's). Though, mostly long ago and before I got away from the overly extraverted clinical psychology types. I've always gotten along better with the engineering/basic science crowd. I think, in some ways, the touchy feely psych types tend to pathologize introversion and nerdy interests (sci-fi)/attributes (i.e., have an iq over 100 . . . I kid, I kid). It's part of the interview in the gold standard asperger's assessment (ADOS). Anyway, if you do well on an individual level and make good connections with people, you are likely fine.

Depending on whether you are just socially awkward/introverted or if you actually have autism spectrum issues, you can learn to look like an extravert. It's simply behavior. There are, indeed, many socially awkward people in academics and in the world, really. I do think it's important to learn not be appear socially awkward, no matter what you happen to feel. It's sales. It's an important skill. I have little interest in psychotherapy though I was reasonably good at it. And, you still need to have good interviewing/empathetic skills in a clinical setting whether you're doing assessment or therapy. It's also necessary, in my opinion, to be successful in an academic setting. Someone truly autistic I think would struggle unless absolutely earth shatteringly brilliant in an academic environment. There's just too much of a political element for that to work. You'd be better off programming software somewhere than in an academic department playing with sharks.

I would work on developing "refined people skills" regardless of whether you go into psych.

Ah, programming... I've heard its siren's call all my life. There are so many reasons why becoming a professional software engineer would be a gamble in my case--not least of which is age. A psychologist can work until he is 80, while I don't see any geriatric programmers. If I were <18, I would probably agree--unfortunately, my ASD/PDD while known to my parents, was never disclosed to me, and I didn't have the opportunity to make early, critical career choices based on the knowledge that I would be forever behind the curve at tasks.

Luckily for me, the positive, 'quirky' things associated with ASD are becoming increasingly more acceptable. Unfortunately, the traits that come with ASD are genuinely crippling in some ways.

I completely agree that the political element would be a huge challenge, and its made be think twice as to whether I would like to be the nation's oldest software engineer.

 

[smalltownpsych]

That's very interesting... What about a therapist who was more of a quiet, listener-type?

Therapy hasn't been a big part of my life, but I have seen a handful of therapists at different points for random things--the majority (not trying to cause offense with this to anyone reading) were kind of chatty-cathy, touchy-feely types. To the extent that, in retrospect, they might have missed their vocation in bedside nursing. If I were inclined to continue therapy with them, I probably wouldn't have wanted to return to someone who made me feel like I'm talking to one of my wife's gossip-y soccer mom friends--again, no offense to gossip-y soccer moms.

Is there no advantage in therapy for a more taciturn, studious (male--I understand we're now a minority in the profession) therapist?

You are framing it as an either/or when it is more of a spectrum (not autism spectrum ). You are also conflating introversion with social awkwardness. I actually see these as two different traits. Most psychotherapists are introverted, quiet listener types. I tend to be less introverted than many of my colleagues, but I am definitely not socially awkward and most psychotherapists are not either.

 

[AwesomeAutist]

You are framing it as an either/or when it is more of a spectrum (not autism spectrum ). You are also conflating introversion with social awkwardness. I actually see these as two different traits. Most psychotherapists are introverted, quiet listener types. I tend to be less introverted than many of my colleagues, but I am definitely not socially awkward and most psychotherapists are not either.

Right, I agree--but one of the mechanisms I've used to smooth over some of the kinks in my interactions is to play more of a quiet observer. It's kind of hard to screw that up with awkwardness.

Don't get me wrong, I've learned to restrain my inner Sheldon Cooper, but my natural response to any comment about the weather is "yup, whatever"--something that the patient interaction script followed in bedside nursing has slightly improved.

Something influencing my confidence in being able to work as a therapist--while I don't have any casual friends--is that I've never had a problem maintaining romantic relationships... hear me out.

My reasoning for why this is the case is because (1) I'm sufficiently motivated to small-talk and conceal my idiosyncrasies (in this case, by having to earn a living and live up to my profession), (2) it reduces the number of variables I need to stress about and pay attention to (i.e., it's one person, and there is a clear task/purpose/script), and (3) it defines the relationship within pretty narrow tolerances/expectations (compared to a casual friendship), so I have much less trouble or confusion meeting expectations. To give you a sense of how close to normal I am--while still being characteristically marked as an ASD-sufferer--I've had girlfriends/my wife make the remark that they wish their friends/family knew "the real" me. So, my thinking is, the unique setting of the therapeutic relationship will play up some of the people skills that I've selectively worked at.

I apologize if that's the most bizarre thing you've read all day (or if my concept of the therapeutic relationship is entirely wrong), but I promise it made sense in my head, anyway, before I wrote it out.

 

[deleted343839]

This was somewhat of a concern for me, thank you for touching on it. Part of my experience with ASD (or perhaps just my personality) is that I can be completely oblivious to "duh!" common sense nonverbal cues, but on the other hand I have become particularly attuned to analyzing a person's appearance or actions--to the point where I'm told I'm reading into something too much... but then it turns out that my intuition was correct.

What specialties would you think this would be less of a concern?

Assessment, and especially intellectual or neuropsychological assessment, gives you a lot of one-on-one face time but within a pretty structured framework that reduces the burden of social thinking. It's important to do something you really like, though. Some people love assessment and others not so much (I fall into the latter group, though I have a lot of respect for careful assessment).

On the other hand, working with clients who have personality disorders and high-risk populations (eg, complex trauma, chronic suicidaltiy, etc.) calls for a more fine-tuned "social antenna," IMO.

Also, though we've been talking about clinical careers, as others have mentioned you will find all types in academic psychology. I wouldn't rule out the option.

 

[Doctor Eliza]

What about becoming a psychiatric nurse practitioner? You already have your BSN, so it is likely to be a shorter route than a PhD. Also, I would think that the more brief, focused interactions of an NP would be socially easier than conducting psychotherapy.

Just a thought.

 

[everythingbutcurling]

This thread is making me think of a story I recently heard about. http://www.idahostatejournal.com/me...cle_73030c5e-37aa-5890-bfe3-710b43beffa4.html

I can see some of the parallels between your situation and Yu's situation. This is just an encouragement to think about what it would be like to work with supervisors who may or may not be sympathetic. I still think you could pull it off, though, if you find a supportive department.

 

[AwesomeAutist]

What about becoming a psychiatric nurse practitioner? You already have your BSN, so it is likely to be a shorter route than a PhD. Also, I would think that the more brief, focused interactions of an NP would be socially easier than conducting psychotherapy.

Just a thought.

Naturally, this thought has occurred to me, but there are a few reasons why I would be inclined to throw my efforts toward psychology [first].

1) "AA is a little weird..."--to me that phrase seems more forgivable in a psychologist, as the public seems to still associate its practitioners with being aloof types.
2) PMHNP MSN/DNP can be completed part-time, and are often funded by hospitals using tuition reimbursement. So, if I were inclined and motivated to receive this degree at a later time, I could conceivably squeeze it in--if only by burning my candle at both ends.
3) Nurse practitioners are desperately in need of their Flexner moment. It is currently being taught in nursing school that 'nurse practitioner' is the logical next step of a nurse's career, after she receives her BSN. That is terrifying to me--that all of the student nurses who struggled with dimensional analysis and rounding and dosage calculations... and there were many--will be the future of primary care, psychiatry, and front-line acute care. Like walking onto an airplane and being greeted by the captain, who happens to be the kid in your highschool who got kicked out for selling meth.

But thank you for your thought!

 

[AwesomeAutist]

Assessment, and especially intellectual or neuropsychological assessment, gives you a lot of one-on-one face time but within a pretty structured framework that reduces the burden of social thinking. It's important to do something you really like, though. Some people love assessment and others not so much (I fall into the latter group, though I have a lot of respect for careful assessment).

On the other hand, working with clients who have personality disorders and high-risk populations (eg, complex trauma, chronic suicidaltiy, etc.) calls for a more fine-tuned "social antenna," IMO.

Also, though we've been talking about clinical careers, as others have mentioned you will find all types in academic psychology. I wouldn't rule out the option.

Thank you, I'll keep that in mind.

 

[AwesomeAutist]

This thread is making me think of a story I recently heard about. http://www.idahostatejournal.com/me...cle_73030c5e-37aa-5890-bfe3-710b43beffa4.html

I can see some of the parallels between your situation and Yu's situation. This is just an encouragement to think about what it would be like to work with supervisors who may or may not be sympathetic. I still think you could pull it off, though, if you find a supportive department.

I've actually seen this article somewhere, probably here--I would imagine there's more to this story than perhaps is being shared.

One important difference--just guessing, here--is that Yu, as an international student, wasn't funded? Hopefully, if I set my sights on funded programs exclusively, I will have the department's vested interest in my success.

I have worked in unsupportive environments before. It sucks, but honestly I think it is a bigger danger to identify myself as someone "on the autism spectrum" than it is to simply let people think I'm "a little weird."

 

[smalltownpsych]

I've actually seen this article somewhere, probably here--I would imagine there's more to this story than perhaps is being shared.

One important difference--just guessing, here--is that Yu, as an international student, wasn't funded? Hopefully, if I set my sights on funded programs exclusively, I will have the department's vested interest in my success.

I have worked in unsupportive environments before. It sucks, but honestly I think it is a bigger danger to identify myself as someone "on the autism spectrum" than it is to simply let people think I'm "a little weird."

The connection that was being made is that this student was not able to complete their practicum and go on to internship because of difficulties connecting with patients. If people decide that you cannot connect with patients sufficiently to practice as a clinical psychologist, then this could happen. None of us would be able to advise you on what the potential for this would be. That is something you would have to evaluate yourself. Accurate self-appraisal is another important aspect of a psychologist's skill set.

Also, I completely agree that you would probably not want to identify that way especially since it is a fairly intangible construct.

 

[HannahB]

I am curious about your identifying with this diagnosis. Is this something you carried from childhood? A lot of what you are describing, plus your degree of self-awareness sounds more like social anxiety.

 

[temppsych123]

One option might be to try doing something that involves one-on-one clinical work on a volunteer basis, to see if you like it and how your supervisors in those settings think you are doing. For example, working at a peer counseling center, or staffing a crisis or referral hotline. Those can give you a sense of whether the things you struggle with are going to be a major issue in psychological-type settings, or if you handle it smoothly.

Good luck!

 

[Psychedlady]

Hi all, and thank you in advance for your input!

The situation:
I am an Army veteran and working nurse (BSN).

The problem:
I am socially awkward, and the opinion of more than one psychologist I have consulted is that I am a high-functioning member of the autism spectrum.

The question:
Can a person who is very socially awkward succeed in clinical psychology or are they setting themselves up for failure? If refined people skills ('schmoozing'/networking) aren't critical for patient interaction or teaching (which I understand the meat of clinical psychology to be), are they critically important in other ways that would torpedo my career at a later point?

The details:

From my work history, you can probably guess that I can tolerate social interaction and teach my coworkers to tolerate me. On the other hand, working as a soldier and later going through nursing school and now working as a nurse was/is extremely challenging. I feel like the amount of stimuli I experience in rushed patient interaction is taking years off of my life, even if it is something that I value highly.

However, I have never had a problem with one-on-one interactions--on the contrary, I relish it. It's something that genuinely makes me happy to be privy to someone's most trying times and inner thoughts, and the people that I have talked to have said it is something I'm good at. I suspect this is partly because my interlocutor is receiving my 100% attention, and I clearly value the chance to have this interaction highly because--frankly--I don't have a superabundance of acquaintances to talk to.

I am asking this because I would very much like to stop this habit of mine--jumping from the frying pan into the fire (e.g., from Army to nursing school to bedside nursing)--and I wanted to see if the professionals and students working on this forum could offer any insight. Thank you.

[If it matters, my quantitative skills, GPA, and research are completely 'there' for many PhD/PsD programs--I double majored in Psych.]

For what it is worth I work with a very renowned autism physician and researcher who also probably is (and knows this about himself) on the spectrum. And although awkward and at times gruff or missing cues, he is incredibly genuine, fiercely intelligent, good-hearted, and passionate about helping change the world. The awkwardness is a bit of a moot point in the grand scheme of things. If you have this self-awareness already I don't think you need to be worried, especially in one-on-one dynamics.

 

[AwesomeAutist]

I am curious about your identifying with this diagnosis. Is this something you carried from childhood? A lot of what you are describing, plus your degree of self-awareness sounds more like social anxiety.

Well, I really hate to TMI you or this board, but growing up I had a (now resolved-) speech defect and I was bullied for a number of years in middle to late childhood. So it becomes a little difficult sorting out what behaviors might have resulted from a developmental disorder vs. what are acquired mechanisms from the scenarios I have been exposed to.

I was diagnosed with 'pervasive developmental disorder' as a child--perhaps I'm dating myself here. When I experimented with therapy as an adult, the psychologist was reluctant to speculate on a formal diagnosis--I don't really recall why, but I'm guessing it was because I had figured out a way to make it in spite of whatever I might have and I wasn't joining the high percentage of unemployed ASD-sufferers.

There are, however, other clues that indicate it is probably autism--difficulty with fine motorskills and coordination, flat affect/facial expressions, and things like having to second-by-second regulate my use of eye contact and what I say.

On that last point, it's more of 'over-scrupulousness'--let's call it--in social exchanges, because I am moderating what I do on an intellectual basis rather than instinctual... and, of course, there's the residual anxiety from prior experiences. (I really promise I didn't get into psychology to self-analyze!!!)

All things considered I'm "making it work," but the way I do it is radically different from how my peers do.

 

[AwesomeAutist]

For what it is worth I work with a very renowned autism physician and researcher who also probably is (and knows this about himself) on the spectrum. And although awkward and at times gruff or missing cues, he is incredibly genuine, fiercely intelligent, good-hearted, and passionate about helping change the world. The awkwardness is a bit of a moot point in the grand scheme of things. If you have this self-awareness already I don't think you need to be worried, especially in one-on-one dynamics.

To an extent, this is encouraging--thanks for chiming in.

On the other hand, I think this example falls into what Jon Snow is saying above about the success of "earth shatteringly brilliant academics" as an outlier. I'm in my late twenties and my contribution to human civilization has involved 1) guard duty in the middle of nowhere and 2) the disposal of bodily fluids... not exactly curing cancer here.

What's incredibly frustrating is that, while I know I can do a lot more, I really need to find my place as someone with limitations due to ASD and at my age I am probably looking at only one more serious career change.

There are also surprisingly limited resources that are helpful in doing this, too--so to the enterprising psychologist reading this... perhaps this is an untapped niche?

 

[AwesomeAutist]

One option might be to try doing something that involves one-on-one clinical work on a volunteer basis, to see if you like it and how your supervisors in those settings think you are doing. For example, working at a peer counseling center, or staffing a crisis or referral hotline. Those can give you a sense of whether the things you struggle with are going to be a major issue in psychological-type settings, or if you handle it smoothly.

Good luck!

Funny that you should mention that... In all of my patient interactions as a nurse, I've never had any ASD-related problems, and we frequently have psych/substance abuse patients come through our floor. Granted, the conversations are usually pretty nurse-y and there's not a lot of "So tell me about your mother..." moments, but--like I said above--it gives me a definite professional role and it is much easier to navigate conversations as a friendly, caring health worker.

This is part of the reason why I have trouble identifying with the experience of Yu that was proposed above--I have been involved in another structured interactions in health care environments to believe, whether right or wrong, that I won't *catastrophically* fail in a clinical setting.

My peer relationships are much more mixed, with responses ranging from "this guy is weird" to appreciating me for the 'positive' traits associated with ASD-sufferers.

Thank you, though, for the advice and encouragement.

 

[deleted760483]

Most people seem to be emphasizing finding a job that fits with the person you currently are. What about working on becoming less awkward?

 

[Therapist4Chnge]

Most people seem to be emphasizing finding a job that fits with the person you currently are. What about working on becoming less awkward?

There is always the Bob Newhart approach....

 

[deleted760483]

There is always the Bob Newhart approach....

I would certainly hope someone who aspires to become a therapist believes in the possibility of behavior change and human's ability to improve themselves.

 

[WisNeuro]

One way to become less socially awkward? Recognize and learn to take jokes.

 

[deleted760483]

Not much of my socializing occurs on the internet