Misconceptions about the "real world" and practice

[BSWdavid]

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I thought it might be interesting to discuss the misconceptions we had about working in the filed, that weren't realized until becoming practicing clinicians. What were some of the misconceptions you had about clinical practice? What has been/or was the most challenging aspect of transitioning from student to clinician? What advice might you have for psychology graduate students about practicing in the "real world"?

 

[PsychGraduate]

I thought it might be interesting to discuss the misconceptions we had about working in the filed, that weren't realized until becoming practicing clinicians. What were some of the misconceptions you had about clinical practice? What has been/or was the most challenging aspect of transitioning from student to clinician? What advice might you have for psychology graduate students about practicing in the "real world"?

politics, politics, and no more free pizza😀

 

[BSWdavid]

politics, politics, and no more free pizza😀

Yep, politics is a big one. It is easy to underestimate how political power struggle can influence our work. It is probably the single most unpleasant aspect of the field.

 

[PsychGraduate]

Yep, politics is a big one. It is easy to underestimate how political power struggle can influence our work. It is probably the single most unpleasant aspect of the field.

Also your peers do not just pat you on the back or say "good job!" Or even this is how you can do it better...

 

[BSWdavid]

Also your peers do not just pat you on the back or say "good job!" Or even this is how you can do it better...

Sometimes it really is a "dog-eat-dog-world" unfortunately. Many of us would like to work in a environment that is free from petty competition, tension between coworkers, etc. Many of us are in this profession because we realize that human beings are not naturally harmonious beings, so our passion also ends up biting us in the butt when dealing with coworkers and other professionals.

 

[ClinPsycMasters]

Generally speaking, expect the combat boots of reality to step on your flower of idealism...then stop, step back, and jump up and down on the flower, kick it over and over again, and walk away to come back the next day and the day after.

You need to keep the idealism alive. You need to remember why you wanted to do this in the first place, to spend so many years studying, and now to listen to people's problems. Never lose contact with the fire of your passion. Keep it burning. It's there right under myriad rules and regulations, and mountains of paperwork. It's right behind difficult patients and colleagues, and the helplessness monster that reappears every time you feel too small and the obstacles in patient's life loom too large and unrelenting.

I think it may be useful to keep reminders of your passion on your desk or on the wall, in your pocket, or on your computer. There may be so many problems, so many unanticipated issues in your professional life but also personal life, that you may feel that you do not want to listen to anybody else's problems, that you don't get paid enough for this, that life's not fair, that there is no point in all this suffering....

As long as you remain the dreamer you once were, you will be all right. Every patient is a miracle of biological and psychological engineering. Every patient can improve beyond your wildest dreams. Many won't. Yet many will. Prepare for the worst but always, always expect the best.

I have often wondered if I'm doing the right thing. Should I continue to get my PhD? Should I go into business, arts, teaching? Can I truly make a difference? How can I fix what is mostly out of my control (e.g. politics, economy, biology). Yet, I can make a difference. In fact I do make a difference, whether I like it or not, and whether I'm aware of it or not. So why not make best use of this chance I've been given and make some positive change from this position? Remember, we can even participate in politics to try to make the world a better place for all of us. Every time you feel helpless, immediately try to problem solve. Try to be as creative as possible. Try to accept what you can't change (about clients, coworkers, etc) and change the rest as much as you can. Pace yourself.

 

[docma]

Students I supervise sometimes voice their surprise at the discovery that, while they loved the fact that they were ready to be "off the leash" in terms of lots of supervision, no sooner was it gone than they missed its availability. It is great to feel licensed and independent but it can also then be difficult (or expensive) to find the right person to "go to" when you need consultation.

 

[Therapist4Chnge]

The Real World Isn't Fair
The biggest complaint I hear from people is that the RW isn't fair. I actually prefer it this way because "fair" can be such an arbitrary thing, first taught to us during our "everyone wins" exercises in grade school. It isn't realistic and it undermines innovation and success. The RW has clear winners and losers, and that is how it should be.

Patients Will Be Waiting For Me To Hang My Shingle
I have lectured on the Business of Psychology, and typically 1/3 (or more) of the people I meet want to have some sort of a private practice. When I start to ask questions about how they plan on attracting patients a host of poor ideas typically come flowing out. "I'll refer from my hospital job." [typically against hospital policy]. "I'll work with a school." [and beat out the dozens of other more established clinicians in the community?] "I'll accept insurance and make up the money on volume" [Have you seen the reimbursement rates out there?!]

I'll Stay Connected With The Research
I forget the exact statistic, but I believe APA does a semi-regular survey and the vast majority of practitioners out there do not actively research and/or do not keep up with journals (The APA Monitor does not count).

 

[Psy01]

The Real World Isn't Fair
The biggest complaint I hear from people is that the RW isn't fair. I actually prefer it this way because "fair" can be such an arbitrary thing, first taught to us during our "everyone wins" exercises in grade school. It isn't realistic and it undermines innovation and success. The RW has clear winners and losers, and that is how it should be.

If the world were fair, that would mean that the the crappy things that happen to good people happened because they deserved it. Same thing for when good things happen to bad people.

 

[ClinPsycMasters]

The Real World Isn't Fair
The biggest complaint I hear from people is that the RW isn't fair. I actually prefer it this way because "fair" can be such an arbitrary thing,

Yes I also like the complexity of fairness issues though I do make judgments of what is fair and what is not based on my values. For instance, physically hurting a client is "unfair" to the client and I would feel the same way even if I weren't following APA's ethical principles.

first taught to us during our "everyone wins" exercises in grade school.

Find that a bit patronizing....

It isn't realistic and it undermines innovation and success.

I don't think a more fair world would undermine innovation or success, though you haven't defined fairness so let me do some mind reading. There are undercurrents of justifying capitalism in your reply, it seems.

Let's say a therapist has a heavy loan to repay and he thinks that it's unfair that he gets paid peanuts but an unscrupulous therapist, a classmate of him at school who barely passed the tests, is making six figures right out of school. He ponders disregarding his own ideals and values. He has needs too. Should he treat patients as walking wallets? It's not "fair" he might think to himself. But does he work suffer presently? You bet! Does he have energy for patients? Can he present his best "self" while sitting there trying to ignore his financial situation?

In fact, one may argue, he would be more innovative and successful if he were better paid for his services. However, I am not talking about financial success. I am talking about innovation and success in treating patients. Therapists deserve better pay so they don't try to have their needs met in more questionable ways. This is my view of course and I'm making a value judgment.

The RW has clear winners and losers, and that is how it should be.

This is pretty vague but I think you are contradicting yourself earlier when you said fairness is pretty arbitrary. I don't think there are clear winners and losers. If this were true, the fairness issue wouldn't be as arbitrary as you suggest. For instance, the therapist who makes $300,000 a year would be a "winner" and the one who went bankrupt would be a "loser." We do better/worse than each other in different fields and that's the reality. Clear winners/losers do not emerge, not in my book, at least; unless you believe value x outweighs others values, which again is a value judgment. Sure, some things can be improved and some do better than others in particular areas, and for some it can be seen as unfair based on their values. But nobody is the clear winner.

 

[BSWdavid]

Certainly, I have much to learn, but what I have figured out so far is that while we might try to understand human behavior from black and white objective perspectives, how people function and how we help them is mostly gray in nature. In other words, people seek out help when they are struggling with the gray areas of life that don't necessarily fit neatly into objective categories. While it is critical to have a defined theoretical understanding of human behavior we have to be willing to understand each unique client's perspective.

I believe that initially we may seek perfection and assume that a+b=c and that fairness is a given, but in reality, human nature isn't exact, it is quite unpredictable, and fairness isn't an innate aspect of society; while I wish fairness was a requisite in life, the reality is that we, as clinicians, probably wouldn't have a job if it was. We are the dwellers of the gray areas of life, helping people to navigate inequality, unfairness, and conflict, which can be an eye opener for many of us.

 

[Neuropsych2be]

I thought it might be interesting to discuss the misconceptions we had about working in the filed, that weren't realized until becoming practicing clinicians. What were some of the misconceptions you had about clinical practice? What has been/or was the most challenging aspect of transitioning from student to clinician? What advice might you have for psychology graduate students about practicing in the "real world"?

That there is a difference between mere knowledge and developed wisdom.

That human beings are vastly more complex than our theories can begin to encompass.

We do not administer treatments, we create new possibilities.

That psychologists must look outside the discipline to the other social sciences and the humanities.

That we worship at the altar of methodological purity and we enshrine certain forms of statistical analysis as idols to be adored. Idols eventually require some form of sacrifice.

 

[Therapist4Chnge]

Find that a bit patronizing....

I find it to be a realist perspective. The trend to coddle and be overly sensative to this new generation of children just sets them up for failure when they enter the RW and realize that they are not unique snowflakes and that there are clear winners and losers. I'm not advocating to strip away childhood and remove all positive reinforcement, but most children and young adults nowadays are ill-equipped to cope with life outside of their bubble. I'm not limiting this by socioeconomic class either, though there are different challenges throughout the spectrum.

Maybe I'm just tired of seeing a 6th place ribbon for effort.

I don't think a more fair world would undermine innovation or success, though you haven't defined fairness so let me do some mind reading. There are undercurrents of justifying capitalism in your reply, it seems.

I'd agree with that analysis. I think a true capitalist approach is best for all, though I know this assertion has a host of diversity concerns. I don't want to side-track this conversation, so I'll openly acknowledge that these concerns would need to be addressed before a workable solution is found.

Let's say a therapist has a heavy loan to repay and he thinks that it's unfair that he gets paid peanuts but an unscrupulous therapist, a classmate of him at school who barely passed the tests, is making six figures right out of school.

It very well could seem unfair, though it is his choice if he wants to continue to accept peanuts for his work. I'm not sure when our profession adopted a sense of martyrdom, but it is not uncommon to hear about a psychologist lamenting about accepting less money for his/her work, but then justifying it by saying they do it to "help" people. Lawyers, physicians, plumbers, and accountants all "help" people...but they don't have the same level of guilt about charging a set fee for their services.

 

[Psy01]

I find it to be a realist perspective. The trend to coddle and be overly sensative to this new generation of children just sets them up for failure when they enter the RW and realize that they are not unique snowflakes and that there are clear winners and losers.

I agree. Those kid sports leagues where they don't keep score and therefore don't have a winner and loser are ridiculous. Kids need to learn.


"Always remember you are unique. Just like everyone else."😀

 

[teo3099]

.

 

[Therapist4Chnge]

One of the worst things you can do for the self-esteem of a person is to take away the ability to succeed. Being able to fail at something means that when you succeed it's an actual accomplishment. Without an opportunity to fail, how can anything anyone does matter?

Children need to learn how to deal with disappointment. They need to learn how to deal with failure. They need to learn what it feels like to be overwhelmed/unprepared. I'm not advocating for them to do a vision quest to learn how to be a man, but only knowing success leaves a child woefully unprepared to live his/her life. I failed early and often as a kid because I wanted to be the best at everything, and that really informed me about my strengths, weaknesses, and complete lack of proper attention and focus.

 

[teo3099]

.

 

[stigmata]

After 10 years of being a psychologist someone asked me "Is it more important for kids to succeed consistently or to recover successfully from failure in order to succeed as adults?" After a few seconds the answer I gave was "to recover from failure, to overcome the unfair, and to learn about their strengths through failing is far more important than constant success as constant success for most kids has be prescribed". I very much believe this to be true.

 

[Psy01]

You know, when I was little I used to watch Batman: The Animated Series all the time. There was an episode (like, 16-17 yrs ago) I recall in which a young Bruce Wayne was training at a martial arts school in Japan. There was a match in which he was defeated. He then redoubled his efforts at training, and his sensei took note. Wayne said that he was not good enough. "I lost."

The sensei said that each person will lose now and again.

Wayne replied, "I have to be the best there is! No matter what it takes!"

The sensei replied, "Defeat can be more instructive than victory."

 

[ClinPsycMasters]

It very well could seem unfair, though it is his choice if he wants to continue to accept peanuts for his work. I'm not sure when our profession adopted a sense of martyrdom, but it is not uncommon to hear about a psychologist lamenting about accepting less money for his/her work, but then justifying it by saying they do it to "help" people. Lawyers, physicians, plumbers, and accountants all "help" people...but they don't have the same level of guilt about charging a set fee for their services.

I hear you T4P and maybe I am one of those folks "blessed" with a particularly sadistic superego.

However, I find your examples quite...interesting. I don't know about you but I don't consider plumbers to be the most trustworthy people. Same with lawyers and sales people. It sure is a stereotype but people don't go to car dealerships expecting sympathy and understanding. They go in with a protective shield and maybe even a sword expecting to get screwed one way or another.

Accountants are different. Their "integrity" is much more important to us. We need to trust them to a greater extent. Then we come to physicians, and finally to therapists.

I don't remember where I read this but when it comes to professions, clerics and therapists are viewed as the most trustworthy professions. Hence, cases of unethical behavior and breach of trust make the news when it involves a cleric or psychologist though a contractor can get away with worse.

People are bombarded on a daily basis with messages that try to persuade them to buy a product or try this service or buy into a new worldview. Putting down their defenses, they expect better from therapists.

Yet we, as therapists, expect clients/patients to trust us enough to lower their defenses and confess their deepest feelings/thoughts, to become vulnerable to us who are complete strangers. We want to create a trusting atmosphere with people, yet we tell them so little about ourselves. And we have to do this pretty quickly. So we depend on public's view of therapists as honest, principled, and caring professionals.

Of course patients have the option to sue us but that kind of legally framed relationship is unlikely to be as therapeutic--of course I'm assuming a paranoid person with a voice-recorder sitting in the corner saying "what do you mean by that?"

In addition, patients can refuse to cooperate with us. In fact, we "empower" them by telling them that they have many rights, and that includes terminating therapy. Then again, we might label their disagreements as "resistance" or "defense", add a pinch of scare-tactics and a fistful of psychodynamic psychotherapy (I'll take childhood trauma for $2000 Alex) and voila, I'll have enough money (after overhead) to finally afford a brand new Kia.

 

[deleted176373]

Yet we, as therapists, expect clients/patients to trust us enough to lower their defenses and confess their deepest feelings/thoughts, to become vulnerable to us who are complete strangers. We want to create a trusting atmosphere with people, yet we tell them so little about ourselves. And we have to do this pretty quickly. So we depend on public's view of therapists as honest, principled, and caring professionals.

This becomes doubly challenging in the military where there is such a huge power differential and the inherent caste system that separates officers from the enlisted population. Getting military service members to open up can often be very tricky, because their radar is always up looking for the consequences of telling the therapist something that could be career impacting. In general, it's not a reasonable fear, but in some cases it is a very reasonable concern. Psychiatrists and Psychologists got the nickname "wizard" because they had a reputation of making people disappear (leave the military) in previous eras, that stigma still exists.

Mark

 

[ClinPsycMasters]

This becomes doubly challenging in the military where there is such a huge power differential and the inherent caste system that separates officers from the enlisted population. Getting military service members to open up can often be very tricky, because their radar is always up looking for the consequences of telling the therapist something that could be career impacting. In general, it's not a reasonable fear, but in some cases it is a very reasonable concern. Psychiatrists and Psychologists got the nickname "wizard" because they had a reputation of making people disappear (leave the military) in previous eras, that stigma still exists.

Mark

That's interesting Mark. I hadn't thought about those kinds of unique obstacles a therapist faces in providing therapy to officers in the military.

I wonder if in that context, where social status and rank carry so much weight, a more easygoing therapist would do better than a more strict and paternalistic one. Though military teaches one to obey authority, the therapist is perhaps seen as questionable authority; hence, officers feel threatened by him and become hypervigilant and defensive. A casually-dressed and easygoing therapist, one who does his best not to come across as an authority figure (though it may be inevitable) may do well in establishing rapport.

I'm just speculating of course and the opposite may be true. The more authoritarian therapist may establish better rapport, as his dominant style of interaction may be just what the soldier is expecting from an authority figure--who does have considerable power. Therefore, his behavior is more familiar and he comes across as more genuine. This may put the soldier at ease.

See, this is why philosophy is not enough. Speculations can run wild!

 

[justme08]

Hmm, I wonder if female and male service members would respond differently in the question you posed?

 

[Therapist4Chnge]

I wonder if in that context, where social status and rank carry so much weight, a more easygoing therapist would do better than a more strict and paternalistic one. Though military teaches one to obey authority, the therapist is perhaps seen as questionable authority; hence, officers feel threatened by him and become hypervigilant and defensive.

It isn't as much about "questionable authority", but one of perceived understanding/misunderstanding. If a provider is viewed as not understanding the military culture and/or what it is like outside of the wire*, there will be a lot of resistance. Combine this resistance with the fact a provider can pull a soldier from their unit for "mandatory" rest, reassignment, etc....the provider, even with good intentions, is the last person a soldier wants to see. Imagine how you'd feel if you were on "mandatory" rest, and your unit gets ambushed while out on a mission and two soldiers die. Whether or not you could have made a difference will never be known, but the guilt associated with not being there for your unit will definitely be present. The stigma associated with MH is still very present, and many soldiers do not want to be seen as weak or in need of services.

A casually-dressed and easygoing therapist, one who does his best not to come across as an authority figure (though it may be inevitable) may do well in establishing rapport.

It varies, just like most other populations.

*FOBs / Fobbits (slang term for personnel who are deployed but never go 'outside of the wire'/off base) are often lumped into this category. Some MH may go outside the wire, though it can vary greatly. Providers back stateside often are doubted, particularly if you don't have a combat patch....or so I've been told.

 

[ClinPsycMasters]

Hehehe, fobbits! 🙂

 

[Therapist4Chnge]

Hehehe, fobbits! 🙂

Between psychology acronyms and military acronyms, sometimes a whole conversation can be had without saying an actual english word.