Personal Reflections

Some Personal Reflections of Working at Warwick University Counselling Service

1: Aaron shaw, 3rd year trainee (Coventry and Warwickshire course) on placement October 2016- March 2018

Where I first heard about the course

I first heard about Warwick University’s Counselling Service during the placement open day at Birmingham University (The open days run concurrently at Birmingham University and Coventry University). Monique (deputy head of year) and a previous trainee clinical psychologist had a stand at the placement fair in March. This enabled an informal chat about the service. It was great to speak to fellow trainee about their experiences on placement. I then came to the service for a pre-placement meeting to make sure that the placement was suitable for the competencies and goals I required.

Why this placement. My aims for placement

This placement gave me the opportunity to work with a high caseload and work with a diverse population. I wanted to experience a placement outside of the NHS and see how a wellbeing service operates in the private sector.

Best thing on placement

The placement was excellent at being able to give me a high caseload from the start of the placement, and although this was quite daunting at first, it was great to get stuck in. It was such a privilege to work with a lot of people with a wide range of presentations including perfectionism, excessive worry, relationship difficulties, and cultural transitions. During the placement there was opportunity’s to work with more challenging clients. These more complex presentations include self-harm, eating disorders and gender reassignment issues. These broad presentations gives the trainee an excellent opportunity to fulfil outstanding competences.

The counselling team were very warm and welcoming, and there was a daily group team talk to check in with everybody. There was always somebody about, and you would not be left on your own without a supervisor being in the building.

It was great to have my own therapy room (for the entire day) and not have to get up and shuffle around looking for clinical space. The rooms are lovely and create such a positive and safe environment which no doubt helps the therapeutic process.

I was able to develop my therapeutic skills in working in a person-centred way. This was accomplished by working alongside accredited counsellors, and it was useful to hear about different approaches in dealing with various presentations. Spending more time focussing on the therapeutic relationship was really great to broaden my experience in working in a psychodynamic way. This was also replicated in weekly supervision and gave a valuable space to reflect on the importance of the therapeutic relationship.

Admin support was tremendous and will help you organise your caseload. They can also help contact missed appointments and book in new clients to empty slots in your timetable.

Demands on placement

The challenges include working with a high caseload (sometimes seeing up to 13 clients in a 3 day week, with about 80-90 clients over the course of the placement). These challenges on top of other demands of the course were demanding at times and someone considering this placement needs to consider the other requirements of a trainee during the first half of their final year such as data collection and the thesis hand in. However, the issues can be discussed during supervision.

Did I reach my aims?

I did achieve my goals as well as other service requirements such as a service development project and presenting my thesis project during a team cascade training day.

Overall.

The placement was challenging due to the high volume of caseload, but it was a gratifying experience that was well supported by the counselling team and weekly supervision. Due to my time with the counselling service, I am now able to think more deeply about the therapeutic relationship and use a wide range of short-term therapeutic interventions.

2: Bryan Moreton, 3rd year trainee (Coventry and Warwick course), on placement October 2016 – March 2017

I found out about the Warwick University Counselling Service from colleagues of mine on the course who had known people that had previously been on placement and had found it be an excellent learning experience. After finding the service’s website, I was pleased to discover that they offered everything that I hoped to gain from a final year placement. Prior to beginning training on the clinical psychology doctorate, I worked for several years in research. Whilst this provided me with the necessary skills and experience to apply, I always felt that I needed to have a placement where I could focus explicitly on the therapeutic relationship and process with clients. I also wanted a chance to experience therapeutic work outside of the NHS. The University Counselling Service provided me with the opportunity to achieve both of these goals and so much more.

I have been privileged to have worked with a large number of clients whilst on placement with a variety of presenting difficulties. Over the six month placement I worked with well over 50 clients and had opportunity to apply different theoretical models in practice. This has increased my confidence in working in an integrative way. In my previous placements I primarily worked with people from a white British background. However, since working at the University Counselling Service I have been able to engage with people from difficult cultures and ethnicities. This has been a fantastic learning experience and one which I anticipate being crucial as I progress in my career.

Therapists are provided very little information when a client attends their first appointment at the service. In addition, a brief service model is used whereby some clients have only one session. This means that first appointments often involve a combination of assessment, formulation and potentially some intervention. It is not possible to prepare thoroughly prior to seeing a client. In addition, I have worked with people on this placement with difficulties that I had not previously encountered in prior clinical work. At first this was quite daunting as I had a tendency on other placements to perhaps slightly over prepare sessions. However, I soon learned the importance of focussing on the therapeutic relationship in session and drawing on the use of self as part of an intervention. Regular supervision at the service has been fundamental to helping me develop my proficiency with this process.

Although brief clinical notes are kept, there is no need to write letters of formulation or discharge. This means that there is less paper work compared with NHS placements. Instead trainees are able to work on projects specifically designed to aid with service provision. I worked on two projects. The first was a short questionnaire study to explore engagement with the counselling service. The second involved recording and editing podcasts on specific issues (e.g. worrying) for use on the counselling website. I really enjoyed the chance to work on two projects that had significant applications to everyday practice at the service. Indeed I feel the balance between clinical and project work on this placement is excellent and quite refreshing. It is also important to note that the facilities on placement are perhaps some of the best I have experienced to date. Each therapist is provided with an individual office, which also functions as their therapy room. The rooms are modern, comfortable and very well resourced (e.g. access to your own PC). Administrative support for the counsellors is also superb, which helps maintain focus on therapeutic work with clients.

The best thing on placement has been the team at the service. Everybody is friendly, supportive and welcoming. Staff are strongly encouraged to take regular breaks together and that helped me to quickly feel part of this team. It has been a pleasure working with them and I am going to miss them when I leave. I truly enjoyed my placement at the University Counselling Service and feel that it has been a really fantastic learning opportunity. I would highly recommend coming on placement here for those that wish to experience life outside of the NHS and for a chance to concentrate on developing therapeutic skills.

3: Sarah Bell, 3rd Year trainee Clinical Psychologist on placement October 2014-April 2015

I first heard about the University Counselling Service placement from a Psychodynamically-trained Clinical Psychologist that I worked with on my adult placement. She had done the placement several years before and she told me how valuable her experience had been. I was interested in developing my ability to use myself as a tool in therapy but did not feel ready to do a year-long parallel placement in a psychodynamic service. I also wanted to explore my options outside of the NHS and to consider alternative employers for the future.

This placement offered me exactly what I wanted - an opportunity to focus on using the client-therapist relationship to inform my therapeutic work and a chance to see how psychological therapies could be delivered in a different setting. At first, I found it challenging to get used to a new way of working, particularly given my relatively large caseload compared to my NHS placements (I worked with over fifty clients during this placement). However, the supportive counselling environment and explorative supervision gradually allowed me to feel more confident in what I was doing. I found I was able to adapt my existing skills appropriately, which, over time, made me realise how much I have learnt during my training and how helpful my knowledge can be to others.

For me, the best thing about this placement was the opportunity to build my skills in assessing and evaluating an individual’s difficulties and then working with them to develop a strategy for managing those difficulties. Sometimes this involved meeting with clients for just one session and developing a brief formulation with them. On other occasions, I have worked more extensively over six or seven sessions and been able to explore their difficulties further.

The client group at the University is incredibly diverse which meant that I was able to work with a huge range of difficulties and presentations, including perfectionism, eating difficulties, distress relating to physical health concerns, relationship difficulties, cultural challenges and concerns relating to sexual orientation. I really valued being able to work flexibly and tailor the work to the individual because it forced me to actively explore what the client needed and wanted rather than simply seeing them for a fixed number of pre-determined sessions. I learnt how to stretch a limited resource as effectively as possible, which I feel will be a valuable asset when I return to working in the NHS. Knowing that I had regularly seen up to eleven clients in a three-day week helped me to feel more confident that I would be able to work at the level of a qualified Clinical Psychologist.

Although, my main aim on this placement was to develop my individual therapy skills, I also had the opportunity to be involved in other aspects of the service. For example, I completed a project that explored Postgraduate Students’ knowledge and understanding of the Counselling Service and developed a Postgraduate-specific website based on my findings. I was also able to be involved in some of the workshops that are run for students throughout the year.

I definitely found this placement challenging but ultimately it has allowed me to develop my understanding of myself as a Psychologist. I feel I now have a better idea of what life will be like as a qualified Clinical Psychologist and this placement has helped to prepare me for what is to come.

4: Sarah Flanagan, 3rd Year trainee Clinical Psychologist on placement October 2013-April 2014

I first became aware of this placement opportunity after speaking with a peer from an earlier cohort who was undertaking their elective placement at the University Counselling Service (UCS). I then took the opportunity to meet with Samantha at the Job and Placement fair and was invited to come and visit the UCS to meet some of the team and learn a little more about the service before making a decision. I was keen to work in a way that would allow me to work more intuitively with clients through the use of person centred model and with a greater focus on what I might bring to a therapy session. My goals were to increase my confidence as a practitioner working with young adults and to be able to hold a large caseload. The idea of offering a more tailored approach to contracting sessions appealed to me and I was eager to see the results of working with clients for brief contracts (sometimes one or two sessions are sufficient to meet clients’ needs) as well as medium term pieces of counselling work.

My overall experience of working at the University Counselling Service was of a supportive, warm and cohesive team. The structured style of working was conducive to managing a large caseload. This was because it allowed me to more carefully map out how many clients I might be able to see per day along with how I would protect time for clinical supervision, project work and other placement related tasks.

A unique aspect of this placement was having my own therapy room/office, which removed the associated time and stress of having to hunt around for a therapy space, as is often the case in NHS environments. The environment of each therapy room and the waiting room is well suited to promoting well-being and is a noticeably calm place to work. Secretarial support is excellent and whilst being responsible for my own diary, the team secretary helpfully arranged new appointments or retrospective follow ups via an electronic diary which allowed for an efficient service for clients and one less thing for me to have to think about.

I enjoyed the opportunity of developing and delivering a student workshop on ‘Building Emotional Resilience’, which was something that initially appealed to me when I was considering whether to select the UCS for my elective placement. As part of the process of putting together this workshop I decided to attend a couple of existing workshops run by other members of staff at the Counselling Service, which was a really useful opportunity.

I also undertook a small project, which looked at cross referencing a local book prescription scheme alongside the current University provision/system to establish whether anything could be learnt from it and whether the current University provision could be improved in any way.

In summary this placement has provided a valued space for self-development, which has in turn really influenced my personal and professional development. This self-development has been consolidated through the use of a person centred model during supervision. I will take away with me a greater sense of self awareness, and an increased confidence that upon becoming qualified I will be able to carry a large caseload and work in a more autonomous manner.

5: Jenny Doran, 3rd Year Trainee Clinical Psychologist (Birmingham course) on placement October 2012 to April 2013.

"What initially attracted me to undertaking a specialist placement at the University Counselling Service was the client group I would be working with (mainly young adults), and the opportunity to develop my 1-1 therapeutic skills in a non NHS setting. I was also interested in working therapeutically using a person centred approach.

My experience of the placement: I have worked with a large caseload during my placement, seeing around 50 clients in total, ranging in length from just one session to 8 sessions. Presenting issues have included depression, anxiety, self-esteem, eating disorders, relationship difficulties, sexuality, trauma and bereavement. Having limited information about a client before the first session has actually been really freeing, as you have no pre-conceived ideas about the client and can meet them where they are at, rather than taking on another professional’s view of their difficulties. Most clients have been motivated and keen to make changes, which has enabled me to work with them at a more rapid pace, and in some cases explore the underlying causes of their difficulties more quickly than I might have felt able to do in the past.

The setting and structure of the day at the UCS is very calming and containing for both clients and staff, which has been in contrast to some of my previous placements which have generally been more hectic and involved travelling around to different clinics, home visits etc. I feel this really enables you to focus on your clients and the therapy without any distractions. I have also gained an understanding of a different model of service delivery which will be useful for my future career.

What have I gained from the placement? This placement has really facilitated the development of my therapeutic skills and helped me to become more confident in tailoring my approach to an individual client. I am now much more aware of the ways in which I relate to each client and how this can be used to inform the therapeutic process. Through supervision I have been encouraged to pay more attention to the process of therapy and what is happening in the room, rather than the content. This has been both challenging and exciting, as I have been cautious about trying things out but then have also seen how it can have a really positive impact on the therapy when you step out of your comfort zone. I also think I have increased my self-awareness as a result of undertaking this placement. I feel all of these experiences will be invaluable in my future therapeutic work, regardless of the setting or client group.

Who would this placement suit? I would recommend this placement if you are someone who is interested in a person centred way of working and would like to work with young adults using mainly short to medium term therapy. I also think you need to be adaptable and willing to think about trying things that might feel challenging at times in order to get the most out of the placement.

6: Ricky Barrows, 3^rd Year Trainee Clinical Psychologist (Coventry and Warwick course) on placement October 2011 to March 2012.

"What attracted me most to the UCS was the opportunity to work on a short term basis with motivated clients. I wanted to increase my confidence in working with a larger caseload and focus on process issues in a way I had not been able to before.

The UCS has an excellent working environment. All clinicians have their own office and the day is structured to include regular breaks, which the team take together. The team were very welcoming and approachable.

In general, I found the clients to be open and willing to work hard on their problems. As such, the pace of work was much faster than I had experienced in my NHS placements. This helped me to develop a greater sense of belief in my abilities. It has also given me a greater sense of belief in people’s ability to change. Indeed, many of the clients were keen with a high degree of psychological mindedness, which made the working with them very enjoyable. This made seeing up to five clients a day much easier than I anticipated and by the end of the placement I had clocked up more than double the clients hours I would normally expect to achieve on placement.

In additional to helping me manage a large caseload, much of supervision focused on processes of transference and counter-transference. This involved learning to work more with the here-and-now as well as developing my skills in using my own emotional reactions to guide the therapeutic work, which took a little while to adjust to. At the beginning of the placement, I was spending time and energy formulating between sessions in order to prepare for clients, but soon realised this was unnecessary as I learnt to stay alongside clients rather than getting ahead of them. I learnt to trust in my own, as well as the clients’, ability to work collaboratively on whatever they bought to therapy.

Another aspect of my placement was to take on a small service development project. My assignment was to explore the potential of creating a Facebook page for the counselling service. This gave me the experience of working through an idea with a team of professionals and creating something that could be easily maintained by the service.

For Clinical Psychology Trainees, this placement offers an excellent opportunity to get to grips with process issues by using yourself as a guide. It also offers an opportunity to work outside of the NHS and experience a higher volume of client work that is not accompanied by excessive amounts of administration. "

7: Michelle Huggins, 3^rd Year Trainee Clinical Psychologist (Birmingham course) on placement October 2010 to April 2011.

"I first became aware of this placement at the job and placement fair. I was particularly drawn to the amount of 1:1 therapeutic opportunities, along with a programme of complimentary workshops and group therapy. My main goals in this post were to enhance my therapeutic skills and my confidence as a therapist. The team were predominantly counsellors working to a person-centred model and I was interested in learning about and gaining clinical experience working with this approach. At times this was challenging for me because I had not experienced the model previously in any great depth and I was unsure at times about the what, when, why and how of it all!

Through person-centred style supervision I was able to learn to trust myself and the wealth of knowledge that I have obtained via the course and through life up to this point. I also learned to use my emotional experiences to the client and the conversations that we had in the room, which was something I had not been as in touch with during previous placements. Supervision brought these ways of working to the forefront and I had time and space to reflect on my role within the therapeutic relationship. I believe these are core skills rather than model specific or specialist skills and I am pleased to have had this opportunity to try to fine tune them. In addition to the clinical work I was interested in the service model at Warwick Counselling Service. Things are changing in our larger organisations and I was eager to learn of alternative ways of doing things. I wanted to widen my understanding of the concept of mental health difficulties amongst a different set of professionals where I felt there would be less stigma, labelling and hopelessness than other more medicalised settings. I found this to be true.

The service model also interested me because of the structure of the day. The day started with an initial coffee break followed by 6 therapeutic sessions so all appointments fit into one of 6 session times. These were interspersed with a further morning break, a lunch break, and an afternoon break. Each counsellor/ staff member had their own office with a computer and a therapy space and worked to this structured time table. We met together in a common room during lunch and breaks, which gave the opportunity to gain informal peer support, and to get to know one another. This was important because when the breaks were over everyone disappeared back to their office and the rooms were quiet again. There was no hustle and bustle, no ringing phones or people coming and going. It was quiet, calm and a completely appropriate environment for the service provided there. This was very different to any service I had worked in before and I had to go through a cultural change before I was able to adapt to it fully. During my 5-month placement I worked therapeutically with 20 clients aged from 18 to 26 years old. They presented with a range of problems bringing them into counselling including academic pressures, anxiety, panic attacks, depression, suicidality, self-harm, sleeping difficulties, bereavement, low self-esteem, sexual difficulties, loneliness, family and relationship difficulties, abuse histories and trauma memories as examples. I worked therapeutically with people during a 50-minute session each week for between 2 and 13 weeks (average 6 sessions).

I enjoyed the variety of the work and the speed at which the clients felt able to address their difficulties and take responsibility for initiating and maintaining a change. I enjoyed working to the person-centred model and the best feeling was when clients took ownership for their recovery and acknowledged that they had done the work themselves and had not been told what to do by me. This was a challenge at first because part of me wanted to hold on to feeling that I had initiated change, I had made the difference, I had made the links and been the catalyst in their improvement but another part of me felt proud of these clients who had often fought with themselves to bring about a change that came from within and would hopefully be maintained throughout the rest of their lives.

Another aspect of my role was to design and deliver a presentation to the staff team about the similarities and differences between counselling and clinical psychology. I also took on an interesting project looking at how the website could be used to inform service development and I prepared and delivered a presentation to the team about this which was followed by a group discussion on service development. There were two CPD events during the placement that I was invited to and attended (both of which I delivered a presentation at!). I also attended a workshop from the many listed on the programme on self-esteem.

In summary, there are many differences to working in this role, which provide a unique experience for developing therapeutic skills. To compliment these differences there are also a wealth of similarities which enable us, as clinical psychology trainees to adapt and work well within this team."

The UCS has an excellent working environment. All clinicians have their own office and the day is structured to include regular breaks, which the team take together"

I definitely found this placement challenging but ultimately it has allowed me to develop my understanding of myself as a Psychologist. I feel I now have a better idea of what life will be like as a qualified Clinical Psychologist and this placement has helped to prepare me for what is to come.