This is a reflection on my recent experiences of starting a DClinPsy course as someone who has struggled with their mental health (and sometimes still does). Inspired by the bravery of others who have spoken about their experiences of both providing and using mental health services, I am sharing my thoughts with the primary aim of letting others who are experiencing something similar know that they are not alone. I also hope that this might be useful for other trainees who haven’t experienced significant struggles with their mental health, along with staff delivering and facilitating DClinPsy teaching.
I’ve spent a lot of time thinking how to write this. I’ve gone through various iterations, later realising that I’m “cleansing” my narrative in order to make people feel more comfortable, to soften the blow and make this more palatable. I wrote the words “I want to preface this by saying that…” and was about to launch into phrases such as “not all clinical psychologists…” and “I know how lucky I am to sit here on a DClinPsy course…” and “I want to clarify that my fitness to practise is continually monitored to make sure I’m not a danger to others…”. And those statements are true. But those statements are also indicative of the environment that I’m operating in. That I should be especially grateful to be here and have slipped through the net onto “the other side”, that my truth is too uncomfortable to be spoken and needs to be altered in order to fit in and maintain the status quo. All of the above are the reason I wanted to have this outlet, and an anonymous account is the only safe way I can do that right now. My truth is raw, painful and messy.
Before starting the course, and long before applying, I spent a lot of time thinking about what it would be like to train to be a clinical psychologist. I’ve struggled with my mental health since my very early teens and used mental health services for over half of my life. I am, or was, “that” “heart-sink” patient. My life has been documented in piles of medical notes. I grew up in mental health services and have many, many battle scars to tell the tale. I had also worked on “the other side” in various roles, and had experience of encountering mental health professionals and those in position of power to “service users”. I’ve been in that position of power on the “other side” listening to people who have similar stories to mine. I was prepared to encounter stigma and cover topics that mirror my own experiences. I’ve spent a lot of time, both in my own therapy and with those closest to me, thinking about how this might affect me and how I should manage this.
What I wasn’t fully prepared for, was the visceral and painful experience of feeling so acutely that I don’t belong. For feeling so utterly ashamed of who I am and where I come from. That I don’t belong to sit in this room; that “people like me” aren’t meant to be in here, that I’m different. That my experiences need to be cleansed and edited in order to be acceptable and fit into the mould of a trainee clinical psychologist. I wasn’t prepared for the aching sadness, the frustration, the anger and the loneliness. I’ve dreamed of being a clinical psychologist for years. I feel so privileged and grateful to be here, and to have the opportunity to support people in distress and fight for social justice and a better mental health system. But it is tinged with a lot of pain and sadness.
The first time someone put their hand up in class and gave an account of their “[INSERT DISORDER] case” in an apparent attempt to exemplify their competence and proficiency as a therapist I felt my stomach lurch. Or the time when someone spoke about self-harm in a stigmatising way I felt physically sick. Or the time that I overheard someone say they’d pick to play someone who had dissociated in a roleplay because it would “be easy”. Or the speaker who gave a particularly detailed description of a client’s self-harm. Or every time we talk about “these patients” or when a lecturer talks about a particular therapy and makes sure to clarify “I’ve not had X therapy, but if I had it would look like…”. Or when a lecturer talks about their “most difficult” cases. Or gives a very graphic description of self-harm with the function being to shock or add effect.
My truth is I am all of these things. I grew up in an abusive, volatile, frightening home where I never felt safe and had nobody to turn to. I didn’t get the opportunity to form safe, secure attachments. I still live with my abusive mother’s voice berating me in my head. I exhibited distressed behaviour for at least a decade before anyone properly asked why. I self-harmed for over seventeen years. I’ve experienced depths of despair I wouldn’t wish on anymore. I’m your severe and enduring, nightmare, heart sink, complex trauma case. I’ve harmed myself in numerous ways. I’ve tried to end my life more times that I can remember. I am very, very lucky to be alive. I’m one of “these patients” who landed up with multiple disorders and was told that my death was inevitable, that I was attention seeking, manipulative, a silly little girl, spoilt brat, a professional patient etc etc. I’m one of the patients who has been punished for self-harming. I’ve had just about every kind of therapy you can think of. I still take antidepressants. Sometimes I still dissociate. But believe me, it’s anything but fucking easy. Despite years of work, I still feel the terror of being used, abused, humiliated, sexually assaulted. It’s something I’m still working on. I’ve taken risks and shared my agony with therapists who sat with me in that pain. I’m fortunate to have a wonderful therapist who is helping me unpick years of trauma compounded by trying to navigate a re-traumatising mental health system. I’ve shared my agony with her and told her things that I’m deeply ashamed of. I’ve sat and sobbed. I’ve dissociated. I’ve tested her, pushed boundaries and said horrible things, mimicking the abuse I’ve experienced. And in return she’s shown me kindness and compassion. She holds my story and helps me make sense of the horrific things that have happened. She has sat with me in my pain. She tells me she’s inspired by my bravery when I push her away and act in ways I feel ashamed of. The idea of her using my story and my agony to show boat in a class fills me with disgust. How fucking dare you use someone in that way? We hold so much power and privilege. When someone demonstrates such bravery and courage to share their story it’s our responsibility to hold it and honour it with the care and respect it deserves. It’s not your story to tell, and it’s definitely not yours to boost your ego. Please think about why you might do that.
The prevailing sense I have been left with when reflecting on my experiences so far is that of being “othered”. The importance of self-care has been mentioned, but we don’t fully explore why self-care is important. We talk about exposure to stressful situations and supporting people experiencing considerable distress, that we have a professional responsibility to look after our physical and mental health (which are all vital and valid), but we don’t name the elephant in the room. We don’t talk about the high prevalence of mental health problems in the “helping professions”. We don’t talk about the high likelihood (almost certainty) that at least one of us sitting in the room will have struggled with our mental health at some point, may be struggling now or may struggle in the future. Or we’ve supported a loved one with mental health difficulties. Or it’s touched our personal life in some way. We are happy to normalise this for clients as part of therapy. But not for ourselves. It’s safer to “other” people with mental health difficulties. We’re encouraged to be reflective practitioners but not once have we discussed why we’re sitting here. Why are we drawn to support people in psychological distress? What does that say about us as people? What have we experienced in our lives that has drawn us to this career? Are we drawn to help people? Do we like the power? Why?
I’ve read accounts of clinical psychologists stating that we should have our issues “resolved” before we enter the profession. But what does that look like? How do we operationalise that? How do we measure it? We seem fairly comfortable as a profession to “accept” people who have struggled with their mental health and have now “resolved” this. But I don’t get to “resolve” my family. I didn’t choose to have the experiences I’ve had and the memories I’m left with. I can’t “resolve” my self-harm scars. I can’t undo the years of my life I lost. I still have things to work on. Sometimes I still feel scared, anxious, overwhelmed, in pain, ashamed, low and filled with self-doubt. But this shouldn’t be mistaken as a lack of resilience or a sign that I can’t do my job; rather an indication that I’m a human being. Just like our clients. As a profession, we are happy to let our clients sit with discomfort; we do it every day as a fundamental component of psychological therapy. And I think as a profession we need to do that too. We need to get really uncomfortable. Why are we so uncomfortable with the notion that we are human and vulnerable to the same struggles our clients have? We are not superhuman and immune to distress because we sit on the other side of the therapy room at work. The extent and impact of difficulties may differ, the intensity of emotional experience may be less, the people sitting in front of us are very likely to be experiencing significantly more hardship and adversity than us sitting in a highly privileged position. But at the core, we are the same.
So, for anyone who is sitting feeling any of the things I’ve described (or anything not mentioned), you are not alone. I’m exhausted and overwhelmed. I’ve sat in the toilets in breaks and cried. I’ve had sleepless nights. I’ve felt that I’m not good enough to be a clinical psychologist; I’m too mad, my story is too much, I don’t belong here. I’ve felt white hot rage at some of the reflections of some colleagues who say downright offensive, stigmatising things with an incredible lack of insight and compassion. I’ve wanted to walk out of the room and never come back. But then I remember why I’m here. I remember the nights I never thought I’d survive, and the times people told me I was useless, worthless, manipulative and a waste of space when I was in agony and desperately trying to find a way to survive. The rage and sense of injustice associated with my own experiences are what drive me to fight. They can make me vulnerable. But they also make me tenacious, determined and resilient. I’m here too. I deserve to be here. And I’m not going anywhere. So please, please think about those of us holding multiple identities in the room. And if that makes you uncomfortable, or think it could never happen to you, reflect on why.