PhD/PsyD Disability during internship: Concerns about addressing with director of training

[William James]

Hi everyone,

I am new to SDN and this is my first post. I have a concern that I could really appreciate others' feedback on.

I recently matched for clinical internship (at a VA) and will begin this summer. I probably have the usual mix of nervousness and excitement, but I also have a disability concern. I am going to give a fair bit of detail in addressing the concern, just because I think it's important to know to understand my case. I'm numbering each point for easier reading.

1. I have a moderate case of narcolepsy. I don't have it nearly as bad as many people, but it's a classic case and is as legit as a diagnosis of narcolepsy can be. I don't normally think of myself as "disabled" because I manage quite well during school, with the combination of medication and a brief nap in the afternoon. I have had it for about half of my life and now and have learned to adapt quite well. Hardly anyone would know I have a problem unless they spend lots of time with me or I tell them. I have almost never disclosed my narcolepsy in academic or employment situations, and in general I get along just fine because academic life affords me the flexibility I need. It's a big reason I am going into academia!

2. However, I know from experience that working a regular "8-5" job moves my problem more firmly into "disability" territory. Fortunately, I usually do quite well when talking with others, but there would certainly be days when I will struggle to stay awake (especially in the afternoons). This is especially the case when I am more passive, as in observing others, didactic sessions, and so forth. Another concern is traveling home, when I may be at risk. (I do quite fine at driving short distances; I know my limits, but driving home after a full day's work is stretching those limits.) Although I take a specialized stimulant medication (modafinil), consuming caffeine is not a solution and actually makes things worse.

3. As is typical of people with narcolepsy, I can nap almost on demand. Even a brief nap (10 minutes) can do wonders. Ideally, I would have a half-hour to nap right after lunch in a private place, and then either stay 30 minutes longer or arrive 30 minutes earlier. This small accommodation would make a world of a difference, essentially removing all impairment. However, it may require some creativity on behalf of me and the site; I likely will not have my own office. Also, the site generally has fairly fixed hours, but I think there can be flexibility for me to arrive earlier or stay later and do notes.

4. I have not yet disclosed my narcolepsy to the internship site, but I am leaning towards doing so in hopes that reasonable accommodations can be made. Although I suspect the site will be accommodating, I have reasons to be concerned: (a) in my experience people have a hard time understanding narcolepsy; it's a very rare disorder and one that is frequently confused (by people who ought to know better!) as laziness or poor habits, (b) my moderate case of narcolepsy may make the site feel less inclined to be accommodating; they may see my requests for accommodations (a nap!) as "luxuries" rather than "necessities," (c) the site may be sympathetic but feels like there is nothing they can do, when in reality they simply do not want to bother, (d) the site will be accommodating but makes a much bigger deal out of it than they need to, and constantly puts my alertness under the microscope, which honestly will just make things worse, or (e) the site may be upset I did not let them know sooner. I think the site would be legally obligated to make reasonable accommodations, but I of course would prefer not to begin my relationship with them in legal terms (I likely would cop out, honestly). An underlying psychological issue for me is that this kind of disclosure is something that is not usually required of me; I have the luxury of not having a visible and constant disability. That luxury, however, has costs in other ways.

5. I will be visiting the area where I am interning soon to secure a place to stay, and I am thinking of requesting a meeting with the training director to discuss "a disability need." I would much rather talk about it in person.

What suggestions do others have for me? Have I thought this through? Other things I should consider? Are my concerns legitimate? Any help, encouragement, cautions, etc., would be greatly appreciated!

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[AcronymAllergy]

Personally, I'd say it's certainly worth discussing with your internship director if for no other reason than to avoid potentially negative reactions should you run into problems in late-afternoon meetings/didactics and the like (nearly all of my internship and fellowship didactics, for example, have occured at the end of the day). I'd be surprised if most psychologists aren't at least moderately familiar with the diagnosis/concept of narcolepsy, even if they haven't personally worked with folks with the condition.

And I agree that (IMO), talking it over in person would probably be best.

 

[psych84]

It is definetley something you should discuss with the internship director. Based on what you've described, this issue does not pose any major limitations and doesn't require an unreasonable accomodation. In fact, if I was a director, I'd be very open to accomodating you and allowing you to take 30mins/an hr, as long as that gave you enough rest/power to be able to stay an extra half hour or so.

 

[CheetahGirl]

In the world of Human Resources for most jobs, labor laws entitle you to two (2) 15-minute breaks and one (1) 30-minute lunch break for every 8-hours worked (although most people stick it out and take an hour lunch). Keep that in mind when professionally approaching your supervisor. I did well with those breaks when I was pregnant & working full-time...and used all 3 breaks to nap. Good luck!

 

[William James]

Thanks, everyone, for your replies so far. They are all helpful.

CheetahGirl, my internship has a half-hour lunch built into it, but that is not going to be enough to eat and take a nap (or at least will be difficult to pull off). I couldn't tell: were you suggesting in your message that people have the right to combine all break time into an hour lunch?

 

[CheetahGirl]

Yes...employers will usually state so (that you have a 45-60 min lunch, but technically many unions have fought for breaks every few hours...remember passe 'smoke breaks' which evolved into water cooler talks?) ...but talk to HR @ the VA and your supervisor to see if you can divide up if you physically need...I had the need (b/c of pregnancy) and my pregnancy (which is technically considered a 'disability' in terms of labor laws) never got in the way of my work. And I went thru two pregnancies prior to graduate school when I was full-time employee...so I'm familiar with employees' rights (and I don't think these benefits have changed too much in the past decade).

 

[docma]

Definitely try to find a way to have the conversation on your upcoming visit, rather than once things start. It is much easier for a TD to build in accommodations if they have advance warning. Scheduling details often get worked out way ahead of time and it is much easier to adjust if you have time to do so, rather than being surprised during orientation.

 

[MCParent]

Just have a talk with the supervisor/TD. I have a medical condition that requires me to eat much more often than most people, and because I'm pretty big a cookie isn't going to suffice. I talked about some simple ways to adapt for this, and adapted my own needs to fit the site (e.g., having those plastic canisters of fruit that I could eat super quickly if a patient ran over time, so I could maintain my health while not messing up my schedule).

I'd have the conversation with your TD if I were you, if only to avoid people perceiving your fast naps as slacking.

 

[mypointlesspov]

Reviving this old thread because I'm having a similar problem now.

For context: I have excessive daytime sleepiness coupled with low-quality sleep overall. I see a psychiatrist and psychologist for this and my primary care provider is aware as well, but nothing has helped so far and things seem to be getting worse. I had an at-home sleep study done saying that I am not getting enough stage 3 and 4 sleep.

I had my first group at one of my externships the other day and absolutely struggled to the point where I was starting to hallucinate. It was terrifying. I get tired while I drive too and sometimes have to pull over to close my eyes for a bit. It's been so hard to stay awake unless I'm up and moving around. Didactics and individual sessions have been quite challenging lately. After the group, I confided in my supervisor about the problems I have with sleep and she seemed really understanding. I emphasized that I have a doctor's appointment in 10 days and I am hoping to be prescribed new medication to combat the daytime sleepiness. I am very much an advocate for myself and I've researched possible solutions to this problem.

Today I got a call from the same supervisor saying that I am no longer going to co-facilitate the group because I look too tired and like I'm not paying attention to people. Apparently she spoke to the director and told her about my sleep problems and they agreed to this as a solution. I was quite taken aback as I have never had a complaint about my performance before today. In fact, my supervisor said they were happy with the work I'm doing otherwise. I am speaking to the director tomorrow and I'm not sure if I should bother to advocate for myself and try to get the group back or if it's a fair decision. Any help is appreciated. I feel like this should have been something that the director, my supervisor, and I discussed before actions were taken.

I should add that the group is not scheduled until two weeks from now due to a holiday so in theory, I would have some kind of solution from the doctor before the next group takes place. My supervisor is aware of this.

 

[WisNeuro]

I had my first group at one of my externships the other day and absolutely struggled to the point where I was starting to hallucinate. It was terrifying. I get tired while I drive too and sometimes have to pull over to close my eyes for a bit.

If it's to this point, I may consider a leave of absence until this is all sorted out. I agree that discussions should take place between interested parties, but it sounds like a significant health concern that would almost certainly be affecting work performance.

 

[PsyDr]

@mypointlesspov

While disclosing a disability and asking for reasonable accommodations is technically the right thing to do; I wouldn't have done it, and I surely wouldn't make more of an issue about it than it already is.

 

[psych.meout]

Honestly, the most concerning part is the driving. What happens if you're on the highway or in heavy traffic and can't pull over to close your eyes? This sounds like a danger to you and everyone else on the road.

 

[mypointlesspov]

If it's to this point, I may consider a leave of absence until this is all sorted out. I agree that discussions should take place between interested parties, but it sounds like a significant health concern that would almost certainly be affecting work performance.

That was an option given to me by the director when we met on Friday, but I am trying to avoid it for the sake of my clients. Individual sessions are challenging at times, but I can push myself through for the post part. Additionally, internship applications are due soon and I honestly don't want to damage my reputation further. However, I have a doctor's appointment next Monday and if we can't think of a viable solution, I may ask to change my hours to something that may be more manageable. Wednesdays are my toughest day since I'm at my externship for 10 hours. I was also told that I may be able to take short naps during the day when there is downtime which seems like the most realistic solution.

@mypointlesspov

While disclosing a disability and asking for reasonable accommodations is technically the right thing to do; I wouldn't have done it, and I surely wouldn't make more of an issue about it than it already is.

At that point it felt like I had no choice. I was sitting across from her and was visibly tired, so I didn't want her to think that it was just because I was lazy or something. I'm trying to downplay it as much as possible, but now I'm worried that more people here know than I'd prefer. On Friday, the director told me that they previously had a student who was falling asleep during individual sessions (to the point where clients were asking what was wrong with her while the sessions were being recorded) and that former extern blamed it on being a tired graduate student. The director also essentially told me that they weren't mad at me because my clinical skills are great otherwise unlike the other person she mentioned. It just feels like this was all thrown in my face without a chance for me to defend myself. I honestly cried when my supervisor called to tell me that I was being pulled from the group.

Honestly, the most concerning part is the driving. What happens if you're on the highway or in heavy traffic and can't pull over to close your eyes? This sounds like a danger to you and everyone else on the road.

It's quite scary. At this point I've changed my routes to work to ensure that there are safe places for me to stop. It's not like I immediately fall asleep or anything, I can tell when my eyes start to get heavy and then I have time to focus on getting somewhere safe.

 

[TiptoeConqueror]

Reviving this old thread because I'm having a similar problem now.

For context: I have excessive daytime sleepiness coupled with low-quality sleep overall. I see a psychiatrist and psychologist for this and my primary care provider is aware as well, but nothing has helped so far and things seem to be getting worse. I had an at-home sleep study done saying that I am not getting enough stage 3 and 4 sleep.

I had my first group at one of my externships the other day and absolutely struggled to the point where I was starting to hallucinate. It was terrifying. I get tired while I drive too and sometimes have to pull over to close my eyes for a bit. It's been so hard to stay awake unless I'm up and moving around. Didactics and individual sessions have been quite challenging lately. After the group, I confided in my supervisor about the problems I have with sleep and she seemed really understanding. I emphasized that I have a doctor's appointment in 10 days and I am hoping to be prescribed new medication to combat the daytime sleepiness. I am very much an advocate for myself and I've researched possible solutions to this problem.

Today I got a call from the same supervisor saying that I am no longer going to co-facilitate the group because I look too tired and like I'm not paying attention to people. Apparently she spoke to the director and told her about my sleep problems and they agreed to this as a solution. I was quite taken aback as I have never had a complaint about my performance before today. In fact, my supervisor said they were happy with the work I'm doing otherwise. I am speaking to the director tomorrow and I'm not sure if I should bother to advocate for myself and try to get the group back or if it's a fair decision. Any help is appreciated. I feel like this should have been something that the director, my supervisor, and I discussed before actions were taken.

I should add that the group is not scheduled until two weeks from now due to a holiday so in theory, I would have some kind of solution from the doctor before the next group takes place. My supervisor is aware of this.

I have similar issues. My sleep issue was also formally diagnosed with an inpatient sleep study. I was eventually given a medication to help.

I did not use it until I started internship for various reasons, including mostly being anti-meds in general. I was trying really hard to just muddle through. Let me tell you: internship changed all of that. I work an insane amount of hours because that is the only way to get my work done and I don't have the luxury of being able to have even just a moment of my brain not working at optimal capacity. I have not disclosed to my TD or any supervisors because I don't think it would be beneficial. Nothing about my workload is going to change and, if anything goes wrong, it will just be blamed on me rather than the fact that the workload is unsustainable. Perhaps this is just at my site in particular, but I do feel the idea of going to the TD or talking to supervisors about personal things such as this has been more lip service. Particularly with sleep disorders, I do think there is a chance that people will not treat it with the same level of respect as other conditions, even if it might be comorbid with something else (as is my case). Case in point: I recently switched providers and the doctor said of my sleep diagnosis: "I've never heard of that before" and I could hear his muffled discussion with another clinician outside the door that "I don't know about that one but I trust she's probably not lying."

Anyway, I shard my personal experience to say that I think a trial of medication would be really beneficial. Since you've already disclosed to your supervisor, I wonder if it would be helpful to let them know that you are trying a med and would like to be given a chance to do the group. Maybe that will still require some leave of absence until you are stabilized on the medication, but perhaps someone else can speak to that.