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Q&A with a Clinical Psychologist working with eating disorder and anxiety patients

FN: What do you do now?

A: I’m a Clinical Psychology registrar, which means that I have done the two years of Clinical Psych masters and now I’m a registered General Psychologist. I have started my registrar program, and the registrar program goes for two years until your endorsed as a Clinical Psychologist. Technically it’s just a two-year internship where you’re still getting paid pretty well, but you need extra supervision.

FN: And where do you work?

A: I’m working in private practice, that specializes in eating disorders and a range of other niche disorders. I see a range of different presentations, from mood and anxiety disorders like depression, bipolar, OCD, to more specific phobias. I saw a young man who has a fear of moving his bowels, so I’m actually working with him to be able to effectively go to the toilet.

FN: How old is he?

A: He was 9. Very cute. I also see more severe eating disorders, tic disorders and then more complex presentations like personality disorders, which are more common in private practice, if people can afford to go.

FN: Do you find that patients who present with eating disorders are predominately young females?

A: Yes, predominately but there is definitely an increase in the number of males we’re seeing. We’re becoming more aware that they have more hidden eating disorders, that can look more like muscle related as opposed to restricting. Basically, they present differently than a female would with anorexia.

However, things like binge eating disorder is quite common among both genders. Disordered eating (when they have issues eating) which can often be combined with other presentations is still necessary to work through, but it doesn’t meet criteria for an eating disorder.

FN: Can you talk me through a few different cases?

A: I have a client at the moment, who is 15, a young female who also has an anxiety disorder and she has anorexia nervosa. She has a supportive family, so we have been doing Maudsley with her, which is more of a family-based treatment as opposed to an individual based treatment. Essentially, it’s the parent’s job to support them in gaining weight in the first phase of treatment and increasing their BMI up to at least 19. Then as they get better at regular consistent eating, they move into phase two which is then giving the power back to the adolescent and working through the preoccupation with shape and weight, and the underlying beliefs that kind of led them to the restricting behaviour in the first place.

FN: Are eating disorders, something that is a chemical disfunction in your brain? Or is it something that can develop through exposure to say, the media?

A: I think it’s a bit of both. Any disorder you have – you’re born with a genetic pre-disposition, or your temperament that might make you more susceptible or sensitive to reacting to similar in a particular way. So yeah, you would probably have different brain chemistry than someone with no eating disorder. But that doesn’t necessarily mean you’re born with it, it might just mean that you have the pre-disposition and then things in the environment led you to that behaviour.

It comes from attachment issues with parental figures, it can come from this ability of image control or rebellion or it can definitely come from societies impact. You can trace history back and see eating disorders in Asian populations to way before media was a thing. There’s definitely been a spike and that’s more a social cultural kind of disorder in the last 40 or so years.

FN: If every case is different, is part of your job assessing them and saying this is the cause, yours might be wanting control, yours might be a preposition…?

A: Yeah, 100%. The biggest difference between what a Clinical Psych would do as opposed to maybe a counsellor, General Psych, GP, or other health professionals, is what we call a Case Formulation, which is understanding all their background factors. What background factors led to what core beliefs they have and then what kind of cycle or what activating event, classic CBT (cognitive behaviour therapy) kind of formulation. What was the activating event that triggered those core beliefs that led to the current pattern of thinking and the current pattern of behaviour.

And so it’s really that pattern of thinking, and those core beliefs that we’re really trying to understand and target cause that’s what is going to create shift and so every single client formulation is different. I think the exciting part about therapy, it’s really getting to know someone and understand what’s going on for them and how they got there. It can be a really important step for the client as well in understanding that their issue makes sense. Given what they’ve been through and how their thinking pattern has been, and it’s not really their fault and if you understand how it all kind of fits together then you can piece out the treatment plan from there.

FN: Right, so it’s as much about educating them as to the cause of it rather than the tough love saying, “fix it”.

A: Yeah, of course.

FN: Given that you’ve worked with young people and adolescents and sometimes the parents might be pivotal in the problem, how do you go about talking to them about what they have done? Do you find that intimidating?

A: That can be very interesting. The way I handle it will be dependent on the adolescent’s maturity and how much parents are involved to begin with. If they are more on the young side of things, around 12, 13, 14 then it’s actually more helpful to have the parents involved from the get-go. You can use a lot of good family therapy techniques to really foster the communications skills and interpersonal skills between family members but it’s also important to give the adolescent their own space to disclose what’s going on for them.

If they are a bit older then I try to empower them to include their parents as much as possible but also leave it them and try to work with them. Obviously, we know that if there can be a shift in their environment to be more supportive rather than just trying to change the individual, that will help longer term. I might do most of the session with the adolescent and then have the parent come in towards the end of the session. In this time the adolescent can explain to the parent what they have done and maybe work together with the parent of different parenting strategies, like emotional coaching for example, that can support their young person and what they are going through and that relationship.

FN: How do you find the normalisation process? Because undoubtedly you’d have to work with someone through some really hard situations…

A: Yeah, oh definitely. I guess it’s saying that given what you have been through, it makes complete sense that you would be experiencing X, Y and Z. It doesn’t have to come from a place that I’ve experienced. I work with parents on how to best parent kids with oppositional behaviour issues, that doesn’t mean I’m a parent.

So, it’s about understanding, I understand the theory, the client is an expert in themselves and so we are going to work together to improve the situation.

FN: Do you think that someone who has come from a traumatic background would be a better Social Worker because there it comes from a personal experience or is it about the theory and applying it case by case?

A: I think that if you did come from a traumatic background, it might even be harder for you to help, sit with people and process other people’s issues – because you have to cope with your own reactions and your own things as well. Of course, that’s something you would learn, by no ways would that deter you from doing becoming a psychologist. But you also don’t necessarily need to have experience in mental health yourself, to be able to provide the effective treatment.

FN: Did you feel that your degree prepared you for what you do now or does it require a lot of on the job learning?

A: My masters degree, absolutely prepared me. 100%, it was a fantastic degree, and I think most universities have really good programs. I obviously had a great experience at Sydney Uni, so I can attest to their fantastic training. For example, we did neuron placements for three quarters of our two years, where you learn a lot from not only from the supervisors and professors at uni but depending what placements you at.

In regard to my undergrad, absolutely not. The four year undergrad is really a glorified science degree from my perspective. You learn a lot about background theories and a lot about other areas of Psychology besides Clinical or Abnormal Psychology

FN: When you began your degree, did you know you wanted to work in Clinical, compared to say Forensic or say Behavioural?

A: I was actually a bit confused between Clinical and Forensic. I did Neuro Psych course and that really inspired me, and I really saw how the two subjects could really compliment each other and then after working with Forensic lab in my honours year, it really opened up a pathway for me to get into Forensic masters pretty easily. I find that work really fascinating, but I guess to be honest, my main motivation for going into Clinical Psych was the fact that I know I could find work anywhere because I would like to leave Sydney eventually. Forensic Psych roles are probably less available outside of Sydney.

Also, I guess when I started my degree, I think I was pretty hopeful to become a Clinical Psych even though I knew it was really difficult. I actually thought transferring to Social work in first year and I did a couple Social work electives.

I pretty much got told if you can become a Psychologist, you’ll be able to do more effective work, get more support and get paid more. But otherwise, Social work is still a good option.

FN: For someone that is interested in helping people, but they don’t have the marks to do Psychology, do you think Social work is the most similar field?

A: Yes and no. Social work is really tough, I have a lot of respect for the Social workers I’ve worked with in different placements. But yeah, you can definitely help people. It’s in a more relaxed way, a lot more looking for referrals and other support systems and less one-on-one counselling. You can do counselling diplomas and different training courses like that if you’re technically not “smart enough” to do Psych.

FN: What do you love about your job?

A: Ah, this is going to sound so lame but I guess what I really love is that it’s quite a privilege to get to know someone through a therapeutic relationship. People are really vulnerable, they expose a side of themselves that they might not ever have shared with anyone else before, and you have to hold that and help them come to terms with it and process whatever they are struggling with.

I think that is a privilege and I also find it fascinating. I find that process of understanding how that person got to where they were, what’s happened, working through their formulation – it’s kind of like a big problem-solving task. I really feel like we’ve hit the nail on the head if both of us think we’ve got the right formulation. That is not only exciting for me as a Practitioner, but that can be really exciting for the client, who can finally have some validation and normalization, that it makes sense that they are going through what they are going through, given what they have been through.

FN: Okay so how does someone become a Pyschologist?

A: You have to do a four-year undergraduate degree. You can enter into a Bachelor of Psych in a couple of ways – you can either major in Psych through a Bachelor of Science, or you can do a Bachelor of Psychological Science. You can also do a Bachelor of Psych with honours if you get a good enough ATAR, straight out of school. You then have to maintain distinction average in Psych subjects to get into honours at most universities.

FN: I feel like a lot of students don’t know that you need to go on to do post-grad if you want to practice, but can you confirm if that’s absolutely the truth?

A: 100%, yes. I found it was pretty clear at UNSW – I did a Bachelor of Psychological Science at UNSW and got into the honours program there, and it was pretty clear from first year that you have to do further study to become an endorsed Clinician.

There’s a number of options for your two-year Masters; like Clinical Psych, Organisational Psych, Forensic Psych (very rare). There’s only probably a couple courses in Australia for Sport Psych or Child Developmental Psych. The most popular one is Clinical Psych masters, which is what I did at Sydney Uni.

So, you have to do the two-year masters course to become an endorsed Psychologist, which means you earn more money and can essentially do more effective practice as an endorsed Psychologist.

FN: Why more effective?

A: Because you’ve technically done the extra research, the evidence, basic practice and done the extra qualification. You’ve had more supervision, you’ve had a more thorough training through the university course, and you just have to meet the requirements of what you learn in those two years, which is more than what someone who just does the bachelor degree does.

FN: So, if we back it up to when you were in high school, how strong were you at maths?

A: I was strong at maths. I did extension one maths and went reasonably well. Although, I didn’t think that my maths skills were particularly translatable to a Psych degree. In the degree, it’s really just statistics that you need, and statistics were super important at UNSW – they had a really heavy weighting on your ability to get into honours and then also they had a bigger weighting than other courses towards your honours mark.

FN: What was the drop-out rate like? Do you remember how many started in cohort compared to how many finished?

A: That really depended on how many people got good enough marks to get into honours. But also, most universities accept people from other universities for the honours’ year.

It’s really hard to gauge numbers on how many people do first year Psych because so many people do it as an elective or they might try it as a minor and then drop it, or as a major but they don’t actually want to go into honours in Psych. But the honours year had around 60 people, so probably a significant drop from people that were studying in first year. Then the masters programs tend to only have 12 – 15 people in a room.

FN: If I did an undergraduate in Psychology but don’t get the marks to do honours, what would I be doing?

A: Good question, if you want to become a Psychologist then that’s a difficult pathway. You have to do four years to become any type of Psychologist, even a General Psychologist. So, you would be applying to a different uni that maybe have lower acceptance offers, maybe private colleges and/or looking at other avenues that you could use to your Psych skills in, such as law, marketing, business.

FN: Any final advice?

A: I guess my advice, given there is so many hurdles throughout especially Clinical Psych, is that you need a lot of experience to get into masters not just decent uni marks. I got that through doing lifeline – I learnt a lot from the lifeline program, I became very good what they call “Micro Skills” which is basically counselling skills, the ability to really build trust with someone and validate and sit with someone through traumatic times. I thought was very helpful before I went into masters.

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