Transitioning from trainee to practitioner psychologist: Considerations and reflections

For many early career psychologists poised on the precipice of commencing their practice career, there are a multitude of questions to ponder and decisions to be made which have short and long term consequences: private practice, public practice, a specific area of practice, or combinations of public and private work, not to mention the number of hours of work — full time, part time, or after hours work. Whether to work in a solo practice or be part of a larger group, as well as your preferences for supervision and peer support all require careful consideration.

Preparing for the world of practice: the practical, personal and professional

Commencing practice requires attention to a number of practical issues including marketing your services, establishing appropriate business procedures, ensuring compliance with various regulations and regulators such as Medicare, the Psychology Board of Australia and third party payers (e.g. compensation schemes).

On the personal front, early career psychologists will need to deal with how to leave work at the office, effectively alleviate stress and maintain good physical and mental health as these can be the first casualties of work pressures for the newly minted professional. Enlisting the services of a supervisor and mentor will be important as well as a good accountant, business adviser, and legal advisor. Staying connected to your profession through peer consultation groups and membership of your professional association will keep you grounded and provide the support and opportunities for discussion that will be vital to growing your career.

On the professional side, as you have started practicing, you might notice that there is a shortfall between what is expected in the private practice environment (particularly those offering Medicare subsidised brief therapy services) and the skill set that you were taught at university. Many early career psychologists complete their training having rarely failed anything with a tendency to be perfectionistic, and subsequently can find themselves working hard to manage their performance anxiety in front of the client. Less experienced psychologists who are developing their confidence and capacity to be client-focussed can find it difficult not to become self-critical. The learning curve is steep but is often assisted by an appropriate choice of work context and effective use of supervision to enhance assessment, treatment planning and intervention skills. Finding your own professional voice, style and approach becomes critical to becoming a fully-fledged and well-rounded practitioner.

In a recent edition of Psychotherapy Networker (March/April 2015), a number of leading psychology authors and thinkers, including Mary Sykes Wylie, Scott Miller, Mary Pipher, Scott Lilienfeld, Chloe Madanes, and William Doherty, shared their perspectives on what they perceive as the real threats to the future of psychology practice, summarised as:

• A lack of a coherent description of what practicing psychologists do that the public can understand;
• A penchant for stubbornly clinging to intuition and personal experience as guiding lights in therapeutic work rather than trusting science and research to guide us;
• A tendancy to undersell the strength of the solutions that psychology offers to human problems: empathy, goal collaboration and consensus, a professional relationship and therapeutic method of communication with clients that incorporates client feedback which has been shown to deliver superior results.

These real threats are worthy of reflection by the early career psychologist as they navigate the practical, personal and professional challenges of psychology practice.

The private practice option

If you see yourself in private practice at an early stage in your career, there are a number of questions that you may find helpful to reflect on. Business and personal life preferences are interdependent with choices as to how, where and when you want to work with your clients.

Other related questions that you may need to answer include:

• Do I want to work in a GP clinic, in a group psychology practice, in an alternative health clinic setting or in a corporatised/franchised setting?
• Do I want to be a contractor and be responsible for my own superannuation, leave entitlements, work-cover and professional indemnity insurances?
• Do I want to find my own clients or have them referred to me?
• Do I want supervision and/or reception support as part of my package in a practice?
• Do I want to rent a room by the hour and see how I go?
• Do I want to work for a large corporatised private practice and be paid as a contractor?
• Do I want to find a salaried position in a private practice?

A general explication of models of private practice is provided by the APS in the document Models of Private Practice: A Private Practice Guide for psychologists (APS, 2014).

Developing your own style of practice

Early on, a critical step will be to develop a style of practice that works and is effective for you with your potential clients. Most psychologists trained in Australia should have a reasonable level of applied competence with cognitive and behaviourally based therapies. A positive outcome for clients is usually enhanced by collaboration with the client in setting goals that are focussed on their reason for presenting for treatment and provision of interventions that reflect the capabilities of the practitioner. In other words, becoming good at one or two psychological treatment approaches is better than having undertaken minimal training in a number of approaches. Whilst clients will have a preference for the means and methods by which you deliver psychological treatment to them, they are more likely to improve if they acquire a more adaptive explanation for their problems through psychological treatment (Wampold & Imel, 2015; O’Donovan et al, 2013).

Developing your own style will require reflection and time. In writing about how to adapt psychology treatment to address individual client needs, Norcross and Lambert (2013) suggested that six trans-diagnostic features should be considered for each client: reactance level (compliance-defiance continuum), stages of change, preference for treatment modality (e.g., psychotherapy vs medication), therapy method (e.g., CBT, ACT, etc.), therapist characteristics (e.g., gender) and treatment length.

Norcross and Lambert go on to suggest a number of strategies and treatment approaches to enhance the effectiveness of psychology treatment, summarised as follows:

• Systematically vary your directness with clients to enhance treatment results and to decrease drop outs.
• Methods: Psycho-education and emotion generating counselling methods work best for clients contemplating change while skills training and behavioural methods work best for those who are in the action stage.
• Client preferences: An intake or first session review that recognises and accommodates to the preferences of clients (including considerations of treatment method, therapist characteristics and treatment length) is likely to reduce barriers to treatment.
• Coping style: The client’s pre-dominant coping style (blame themselves ‘internalisers’, act out ‘externalisers’ for example) should be matched to the focus of treatment to enhance treatment outcome: internalising clients tend to find interpersonal and insight-orientated treatments more effective while symptom-focused and skill building treatments tend to be more effective among externalising clients.
• Overall the outcome research suggests that reducing symptoms and stabilising clients initially and then switching to more indirect or insight oriented approaches is likely to be effective with most clients.

Reflecting on such models and approaches as you consolidate your practice experience will support you in developing your own style at this formative time in your career.

Help is at hand

So whatever practice option you choose, there are many considerations as an early career psychologist. Certainly, as you traverse the practical, personal, professional and begin to develop your own style, seeking guidance from another more senior practitioner will be essential and availing yourself of the many resources available to help you with your development will be key. Not only for case discussion and input regarding assessment and treatment planning but also to help you consider your career plan to become a master in your field of choice!

Being a psychologist practitioner is an honourable profession and in these days of mental health awareness acknowledged as a legitimate and valued profession in our community.

The author can be contacted at [email protected]