Reflecting on Clinical Training During a Pandemic

Clodagh Cremen

Social Distancing Image

“The strangest of times”

“Stay safe”

“We are living through history”

Things we have all heard so often that they may be starting to sound cliché. I personally recoil now when I hear stay safe, but I have always been averse to a cliché. However, my own personal views on the matter aside – this has been a strange time. It has been a really scary time. We are very much so living through history. As a trainee clinical psychologist this comes with its own specific set of concerns; namely: placement competencies, placement days, placement locations, the placement “counting”, etc.

March 12th 2020

Where were you the day the schools and colleges closed? March 12th. A new flashbulb memory for many. I was in class being taught about Positive Behaviour Support by a wonderfully interesting and witty lecturer. Our course director came in to give us a much needed and comprehensive update on the situation. He mentioned redeployments, health care assisting, contact tracing, the colleges closing by the end of the week and our teaching being moved online. There have only been a few times in my life where I have lost my hearing because of shock and this was one of them. Time stopped, my vision tunnelled, and the room started to spin. I recall people asking questions, but I cannot remember what they were. I remember getting up and leaving the room abruptly, moving to the bathroom to go and cry. I met three other people from my class crying there too. Within (what felt like) minutes, we had received the Redeployment Policy from our employers. We anxiously questioned where we would be redeployed to – most of us anticipating contact tracing. By the end of the day the Taoiseach had announced the closure of schools and colleges. Our new reality had begun.

Redeployment

We spent two weeks being sent reading materials online, as the universities also tried to rapidly adapt to what was happening. One by one we started to receive phone calls from the placement coordinators: contact tracing, health care assisting, back to old placements, swabbing, etc. etc. etc. I personally was sent Health Care Assisting. What an interesting experience it was. I kept a reflective diary throughout and let us just say I was not exactly the noble hero running into battle the media may have been portraying at the time.

And so, on March 30th, I started the strangest placement of my life: one that was not part of the plan, which was filled with uncertainty, and which initially I resented. I had originally been expecting to do an Intellectual Disability placement, where I would be working in a residential home for people with Intellectual Disabilities. In normal times I would be doing group work, interacting with day services, supporting individuals, their families, and dealing with a wide range of professionals from different diciplines. Instead, I found myself doing a mixture of Health Care Assisting and Psychology work. This involved supporting people with their intimate care needs, whilst also supporting their emotional and physical wellbeing too.

I was angry. I was very angry. I was angry that I had not been listened to. I was angry that this was my placement. I was angry that I (initially) did not have PPE. I was angry that I had to move across the country. I was angry that I had to move away from my family. I was angry that people were clapping. I was angry that we were lighting candles. I was angry that I was on my own. I was angry that I still had to find cases and clients to work with – that I had to somehow turn this experience into a placement that would meet my training requirements. I was angry that I got moved onto shift work. I was angry that I still had to apply for ethics for my research project. I was angry that I had to somehow find a case study still. I was angry that I had to still complete a placement contract and a logbook.

It is fair to say that my anger and emotional response was not grounded in reasonable or rational thought. I was angry that my life had to continue as normal. Things that I would normally do on any placement, such as logbooks and placement contracts, suddenly seemed to be huge requests. Things that are standard practice, like ethics applications, suddenly appeared as mountainous tasks that I was unable for. Everything had spun out of control and yet, I somehow had to keep going with all the normal things in life too. I wanted to freeze (and in many ways I was frozen), but at the same time I wasn’t allowed to be, and I reacted with a lot of anger.

It took me a month before I could even begin to think about my placement requirements. This left me in a position where I had to somehow squeeze a 3-month placement into roughly 8 weeks. I found clinical work where I could; I completed dementia screening assessments, behaviour support plans, and updated care plans. I completed individual interventions with some of the residents that focused on building relationships. A fellow trainee and I developed support materials for the staff in relation to minding their wellbeing during the pandemic. I was so lucky to have met some amazing nurses and health care assistants on the way who were incredibly patient and supportive of me, which I am so thankful for. We received weekly check-ins from our employers throughout, which afforded us the opportunity to express our concerns. I was also beyond fortunate to have had an incredible supervisor who was honest and genuine with me about what was going on – something I needed tremendously throughout.  

This is not something anyone signed up to, and it was certainly not something I signed up to either.

The Hero Experience

This brings me to the “hero” narrative. It was an interesting experience to say the least. As a trainee clinical psychologist, I very rarely have found myself being considered as a “hero”. What even is a hero: Noble, Brave, Patient, Selfless. Caring, Honest? At that time, I certainly did not feel patient, noble, or brave. I felt selfless in some ways, but only because I was forced into it. I was certainly honest with anyone who would listen to me complain. I absolutely did not identify with the heroes being depicted in the news or on social media. I felt really scared, really angry, and I cried a lot.

I only share this experience because it is important. We have all made huge sacrifices and suffered tremendously both collectively and individually. Clapping for our healthcare workers was important. It helped people; I have no doubt. What helped me was having an incredible flatmate with whom I shared the experience, who allowed me to be angry. Equally, my family did the same (albeit via Zoom). This experience was not fair. Nobody signed up to it, including our health care staff.  The people around me did not try to correct or change my narrative but listened patiently instead and validated what I was saying.

If being a hero means being noble and brave, that can also mean being stoic. We need to be so careful collectively about this narrative, not because what we are seeing is not heroic, but because humans need to be allowed to express how they feel. Anger is important. This experience has not been fair to anyone. Fear is important. There is so much uncertainty around us all the time now. Sadness is important. We have lost our world.

We need to be allowed to share these experiences, which can be challenging when you are also being cast into the role of the brave, noble, and stoic hero society needs you to be. We are all just humans.

The Learning Experience

In terms of my clinical competencies I learned a huge amount about the importance of boundaries, something I had not previously valued in a meaningful way before. I learned to say no to people and to compromise where I had to. I learned to express my anger in a way that was assertive, to communicate it in a healthy way. It is difficult being told you have to do something and that you have no choice in the matter, I think most humans tend to react to this with anger. I learned that this anger can burn you, over and over again in an insidious way. It can be exceptionally painful to hold over long periods of time and it is important to learn how to let go of it, I am thankful that I did. I am thankful that I learned to focus on what I have control over, which was largely around meeting my placement competencies to the best of my ability and respectfully communicating my thoughts to those in charge. Learning to be both flexible and assertive at the same time with those around me was a challenge and one that I am now grateful for; these are skills I will carry forward with me.

Working as a Health Care Assistant whilst also carrying out psychological assessments/interventions was complicated and stressful. I came to realise how important self-care is and had to develop my own resilience throughout the placement. This is something we often ask of our clients and whilst I thought I had an appreciation of how challenging this is, I now know that I did not. Learning to use worry time to contain my ruminations was difficult, as was building mindful moments into my day. It was a frustrating process, reflecting in action at times where stress is high is hugely difficult. It is easy to reflect when things are calm, as they often are when you are a psychologist sitting across from a client. It was really frustrating having to hold myself to account in this way and take responsibility for my thoughts, to accept them as opinions (not facts) and to work towards letting them go. I think as I move forward in my career. I will need to remember these lessons, to appreciate and understand how incredibly demanding the requests we make are. I believe I will move slower, afford more patience, and be more empathic to those I am working with. This stuff is really hard.  I have much more appreciation for being allowed to vent, without the narrative being corrected or reframed; being seen and validated was the most priceless intervention I could have asked for at that time.

These learning experiences were hugely beneficial and ultimately what has helped consolidate them for me has been the process of reflecting on them independently, in my own space, and in my own time. Validating my own anger and asserting it helped me to process what had happened and allowed me to move on from the experience in a beneficial way.

Whilst obviously still anxious, I am also hopeful that my experiences will ‘count’ towards my training still and that I will be on track to qualify on time. I am hopeful that my career will not be affected and that others will value my experiences in the future.  

The rest (as they say) is history. 

I have never been very good at endings.

Author

Clodagh Cremen, Psychologist in Clinical Training, HSE Midwest.