ACP-UK is keen to support our trainee community at this time of unprecedented change and uncertainty. As a first, important step our group of Trainee Representatives from across the four nations have written this powerful address, speaking to the trainee predicament during the Covid-19 crisis and describing the significant skills and competencies trainees have to offer the healthcare community at this crucial juncture. Trainees should be given meaningful roles which allow them to contribute, and to use their training and resources to support colleagues and for the good of our clients and communities.

The Trainee Representatives have also drafted a useful guide for courses and supervisors as to the most helpful and relevant activities for trainees to engage in over coming months. This is based on an informal survey of responses from different courses thus far, and it links key activities to the Knowledge and Skills Framework and relevant considerations concerning infrastructure and support.

Arabella Kurtz, Director of Operations

COVID-19 Address to Trainee Clinical
Psychologists from the ACP-UK Reps

This is a very worrying and uncertain time for us all, on both a personal and professional level. You may be experiencing anxiety around your own and others’ health, and supporting relatives and friends who need to self-isolate. You may also have concerns about supporting people in your teams and/or people accessing your service through this unprecedented time, whilst managing your own personal challenges.

Trainee Clinical Psychologists are facing additional uncertainty, with expected change regarding all aspects of our training and learning: our clinical placements, research and teaching. Those of us who are due to change placement in the coming weeks may have extra worries and concerns: where will you be placed, and will your placement continue as planned, or not? Perhaps you are concerned about potentially being redeployed and the impact this will have for developing the competencies expected at your stage of training. You may feel doubt about whether you have the skills and support to effectively contain your personal anxieties in addition to the distress of others. You may be reaching the end of your training journey and worried about ensuring the completion of your training, and finding a job post qualification.

In addition to these personal challenges there are logistical challenges to consider. Many of us are being ask to work remotely and to reduce face-to-face contact. This may be particularly challenging as trainees; we are being asked to embrace new ways of communicating therapeutically with our patients, whilst we are still honing our ‘business as usual skills’, alongside being monitored and having our competence assessed. There are more existential questions too: What is the role of a Clinical Psychologist in an environment where change is frequent? How will patient care be affected by the reduction in face-to-face contact? Will you be redeployed to undertake work that is not psychology based? What are the associated risks to others and me?

In light of the concerns we have heard, we wanted to remind Trainee Clinical Psychologists that we have a great number of skills. We wanted to encourage services, supervisors and colleagues to see us as a resource to tap into. The trainee community is diverse in terms of what we bring to our courses, and what we have experienced prior to and during training. We have experience of working in a variety of ways that meet the needs of the population we are supporting, be that delivering individual therapies, or supporting communities and teams. We can work to specific goals but also adopt a more fluid and process-oriented approach. We can do this because of the competencies we develop in our training, which we believe are important assets to draw on at this time of national crisis. Not only will individuals need our support, but communities and teams will as well. Some of us may also be providing informal support to patients and families who are suffering economically and socially from the impact of COVID-19.

Leadership activities take on a new importance in order to support staff that are on the frontline to understand, validate and contain their own anxieties, and to process recent events, especially in the context of potentially traumatising healthcare activities. Lessons in psychological leadership can already be taken from other countries. We can support managers and leaders in thinking how to support their frontline staff psychologically, identifying those who are most at risk of burnout or psychological distress, helping them to deliver compassionate leadership and provide psychologically safe work spaces (Ho et al., 2020; Greenberg et al., 2020). Additionally, we can support frontline staff, both in terms of their own psychological resilience and also in managing the psychological impact on those they are treating (Ho et al., 2020; Greenberg et al., 2020). These skills are essential in supporting others to provide care that is not inhibited by personal distress, and to enable staff to develop resilience to keep them sustained throughout these incredibly testing and unprecedented times.

At this time of national crisis, we support the deployment of the psychological workforce to wherever we are most needed. We at the ACP-UK hold the view that, currently, the deployment of Trainee Clinical Psychologists is best aimed at delivering psychological support, leadership and research. This is consistent with the Psychological Professions Network and NHS England Vision for expansion of the psychological workforce. It is important for NHS organisations and national strategy groups to consider the infrastructure, supervisory framework and competency development needs of trainees before they are redeployed so they are used in the most effective and safe manner possible. The circumstances of Trainee Clinical Psychologists will vary significantly, as will their potential scope of practice. We acknowledge the uncertainty at this time for many members of the NHS workforce; the pushes and pulls of their personal and professional life will be strong and multifaceted. Whilst it is a difficult context for all of us in navigating personal and professional boundaries and obligations, we believe that Trainee Clinical Psychologists are prepared for this challenge.

Our training has made us familiar with many of the pressures we currently face. Even in normal circumstances, we deal with uncertainty around what placements we will be allocated to and what our new supervisors will be like. We have to assimilate into new teams, skill up in specialist settings, digest and learn new techniques ‘on the job’, negotiate caseloads and risk with our clinical supervisors, have our values challenged in training, negotiate personal and professional boundaries, and consider the impact of personal circumstances on our professional practice, and much more. Although these are played out in a different context to the current COVID pandemic, the core skills still remain. For some trainees, we recognise the change in their personal situations will have a big impact on their scope of practice. We are working closely with the Group of Trainers in Clinical Psychology (GTiCP), the Division of Clinical Psychology (DCP) and the British Psychological Society (BPS) Minorities in Clinical Psychology group to consider these issues. We encourage trainees to speak to their training courses and placement supervisors to think innovatively and flexibly with them about how to overcome their concerns, and ensure they do not act as barriers to contributing invaluable skills. There is a large scope of practice, leadership and research in which trainees can contribute. We believe that trainees are resilient, highly skilled and adaptable individuals, who are well placed to manage the serious psychological consequences of the current crisis; both during the pandemic, and afterwards.

It is unsettling to be facing a totally new training landscape, Yet there is also opportunity to show our strength as a profession, with the ability to work creatively and innovate in this time of need, whilst trying to maintain business as usual. As difficult as this time may be it does lend us the opportunity to learn new skills and have new experiences. With the ongoing disruption to our research activities, now could be the time to support teams to effectively monitor and evaluate the changes they are making to their services in real time as a result of this healthcare crisis. This may also be an opportunity to collect data for analysis later down the line, to inform healthcare provision in the future. Change is happening at an unprecedented rate, and with less red tape we might have an opportunity to do things in a timescale that would not normally be viable. The ACP-UK are considering, together with the GTiCP and BPS, how we can support trainees’ research activities at this time and promote these skills in services.

There are various dichotomies you may be drawn into during the coming months, and we would like to encourage you to notice where you are on these continua in this very moment, and to think about how you can develop psychological flexibility to shift, as and when required, throughout this experience. The ability to shift is important to help you to look after yourself, your colleagues, and also to ensure patient care is the best it can be.

1. Consistency versus flexibility

Tolerating uncertainty is a difficult process; we have a desire for clarity and consistency to help us make sense of our environment. We encourage you to reflect on the fact that this is never entirely possible, and that consistency in many areas of life as we know it is unlikely at this time. Try to reframe anxieties and see them as an opportunity to practise flexibility. Focusing on our core values can help us navigate uncertainty and provide a compass for the direction of travel when the destination is not currently clear.

2. Responding with fight versus freeze

Where are you on this continuum, and can you challenge yourself to change position to join in the fight against this virus? When we are anxious we may fight; in this case this may show up as a desire to act, to help, to do. We encourage you to invest this energy to support services and patients, but in a planned and measured rather than an emotive way, taking time to think about the pros and cons for both the short and long term. It would also be reasonable to expect to feel overwhelmed, immobilised and frozen by fear, anxiety and panic. These reactions are inevitable psychological consequences of global uncertainty. Notice these responses and be kind to yourself. Share them appropriately with others, your cohort, supervisors, colleagues and trainers.

3. Becoming risk averse versus desensitized

It is unsettling to work in a situation where you sense threat to your physical and mental wellbeing. Traumatic events don’t have to happen to you directly; there is evidence that vicarious trauma can be transmitted through work stress (Saakvitne et al., 1996). However, we can overcome the risk of indirect trauma by: building in choice and control within our workplaces, ensuring we have access to different forms of support and regular supervision; knowing and building relationships with the people we are working with; being sensible with the number of people we are seeing, and reflecting on the internal and external obstacles we encounter that may interfere with providing effective and safe practice.

It is important to remember that what we are experiencing right now is not the norm. You are likely to carry more risk in your workload. As increased risk becomes the norm we may become desensitised to risk: practice self-compassion and try to notice the feelings you experience. Try to maintain a balanced approach to work incorporating less demanding tasks in addition to more ‘risk-oriented’ work. Maintain perspective and notice shifts within yourself, within your service and organisation, seeking support sooner rather than later. These strategies should help provide balance in our daily working lives.

Let’s embrace what lies ahead for now, not forgetting that we are individuals with our own strengths, weaknesses, hopes and fears. We need to keep the perspective that we are working in extraordinary times, whilst remembering we also have an extraordinary skill set to share, which can make a real difference.

We also want to reassure you, and let you know that there is much work being done behind the scenes to support you and the psychological workforce.

Developing guidance

Our Board have contributed to the recent NHS England Guidance for psychological professionals during the Covid-19 pandemic, which offers national strategy for the psychological workforce with several partners, including the PPN and BPS. We have also produced guidance more broadly for Clinical Psychologists in mitigating the impact of COVID-19 at work, the role for clinical psychology in supporting public health and well-being from COVID-19 and advice for Clinical Psychologists who are home working. The concerns that we have are not unique to us, but we wanted to share what we have heard from the trainee community in order to try and find a way forward.

Download the COVID Response Strategy for Scope of Trainee Clinical Psychologist Practice here.

The ACP-UK have also developed a COVID Response Strategy for Scope of Trainee Clinical Psychologist Practice that seeks to provide some structure and guidance to the way Trainee Clinical Psychologists are supported and deployed throughout this crisis in the coming weeks and months. This document also outlines some of the best practice from DClinPsy courses and current placements, as well as Trainees’ current concerns. We acknowledge that we do not have all the answers, but we have worked collectively with input from multiple training courses across the four nations and oversight from the ACP-UK Board. We hope this document can be used to help you, DClinPsy courses and clinical supervisors think about how trainees are deployed in this unprecedented time and enable us to be seen as a valuable resource. We encourage you to use this document to engage in conversations with your course and supervisors to help you define what scope of practice you are able to provide, within your context.

Ensuring your voices are heard

The ACP-UK trainee eps are working with reps from the DCP and the COVID Trainee WhatsApp and SLACK organisers to ensure trainee voices are heard.

Co-ordinating a consistent response across professional bodies and training courses

We have also been working closely with the GTCiP and DCP to ensure there is a co-ordinated and consistent response and strategy for trainees and training courses across the UK. We aim to be aligned in our approach to issues such as deployment, disruption to placements or research, and to ensure where possible that training is not delayed and clinical competencies are still met. Ultimately we want to ensure present and future trainees qualify on time to meet a planned increase in the psychological professions, and an expected increase in demand for our skills following this pandemic.

Linking in with other relevant developments

The HCPC are developing their thinking around the future workforce to ensure minimal delays to practitioner registration (see early registration statement, advice for current trainees/students and adapting current HCPC practice statement). Additional legislation is being developed to help support clinicians at this time. Of note, the coronavirus bill has allowed for easing of registration of health professionals, compensation of volunteers, and indemnity cover for clinical negligence of healthcare workers carrying out activities connected to care, treatment or diagnostic services provided under the arrangements for responding to the Covid-19 pandemic.

This is a context we have not seen before in clinical psychology training. Trainees are well placed to support in this crisis but need support and compassion themselves from their systems in order to do this. We, at ACP-UK, wish to give a strong voice to trainees during this time to ensure their needs are met. We are here in support of you and wish you the best in navigating these new waters. We know you will step up to the challenge that is in front of you.

Response developed by Leila Jameel (Trainee Representative for England), Pauline Insch (Trainee Representative for Scotland), Chris Lewis (Trainee Representative for Wales) and Alex Marsh, Joint Director of Trainees.

With support of the ACP-UK Trainee Representative Team and the Editorial Board

References

Ho, C. S., Chee, C. Y., & Ho, R. C. (2020). Mental Health Strategies to Combat the Psychological Impact of COVID-19 Beyond Paranoia and Panic. Annals of the Academy of Medicine, Singapore, 49(1), 1.

Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2020). Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ, 368.

Saakvitne, K. et al. (1996). Transforming the Pain: A Workbook on Vicarious Traumatization. New York, NY: Norton