Although previous sections of this chapter have presented difficulties experienced by
participants in their transitions, and illustrated the difficulty for clinical training programmes to prepare them for CAMHS environments specifically, it is also important to note that one theme which emerged strongly was of training experiences that participants saw as
transferable to new settings, and thus beneficial for their transitions. These benefits included feeling prepared to not always feel competent, enhancements in their interpersonal and group skills, and attaining direct experience within relevant specialist placement settings.
Participants often looked back at what had help them move forward.
The concept of learning, through clinical training, to feel comfortable with not feeling prepared or competent, was an idea echoed by various participants. This was discussed in relation to not needing to have the answers, or feeling confident, within therapy, in the completion of formulations, or in discussions with the MDT:
…a feeling... [of being] comfortable with the uncertainty of not feeling competent... (Maggie);
…training kind of prepares you for not feeling ready a lot of stuff, and... when things come, you just do it... (Sian);
I felt prepared that I would feel incompetent... prepared that I would feel out my depth and lost... so... [I thought] this is part and parcel of what we do... knuckle down and work out what you’re doing, and that’s what happened... (Amit).
These latter two quotes also reflect a common experience across the interviews; a sense of being able to keep going and being confident that they would eventually be able to manage. Participants reported that their training experiences had given them a resilience to survive the initial challenges of the transition into these demanding and pressurised services, and that they were able to ‘knuckle down’, carry on, and come out of the other side.
Participants also discussed other benefits of their clinical training, including for example experiencing challenging clinical situations, which prepared them for clients they would go on to see in their current roles:
…on training you have to deal with a lot of different situations... some less pleasant than others, you get used to just getting on with things... (Sian).
Helen spoke specifically about how training prepared her for the ‘peaks and troughs’ of CAMHS work, including that the competing demands of both clinical placements and
academic work was challenging when it led to particularly busy times, and that this set her up well for similar periods of stress as a NQCP:
…[training] helps in terms of... trying to organise... think about what needs to be done first and then get through that [stressful period] knowing it’s gonna pass... [training] does help you to not get too overwhelmed... you [learn].... it’s probably not gonna be intense for that long...
Interestingly, Helen’s view that ‘overall, the course prepares you well’ is characteristic of her interview, which was in general a very positive account of her experience as a NQCP in
CAMHS, and of her training. During her interview, I worried that this was not going to result in useful information for this research. I wonder if this was based on my pre-conceived ideas about working in CAMHS, and my previous experiences of working in mental health services for children, CAMHS included. In retrospect, I see that many of Helen’s quotes have been valuable in illustrating the themes presented in this chapter, while it is also refreshing and important to see that some participants, not just Helen, are not only feeling comfortable but
thriving in their post-training roles.
Another commonly expressed view by participants was that training had been beneficial in enhancing their skills in working in teams. They highlighted that their training programmes used the cohort of students as a resource, for example through Problem-Based Learning (PBL) groups, to develop their communication and team-working skills, as well as helping them to experience and manage different group dynamics which may arise. Participants reflected on how they had been able to transfer what they learnt from training directly to the MDTs they worked in.:
…it was brilliant cos we learnt so much about the MDT working and building relationships and group dynamics with PBL... the team working is so important and feeling a connection with other psychologists as well as other MDT disciplines... (Katherine);
…in training we did some work on group dynamics... that’s been really helpful, especially when thinking about the dynamics in the [MDT]... (Frida).
Particular clinical placements that participants had the opportunity to work within were also cited as beneficial in aiding their development in advance of qualifying and taking up a NQCP post:
CAMHS is also a fairly comfortable setting because I’ve worked in a very similar setting as a trainee... (Sian);
my specialist placement was in Looked After Children’s team and that really helped... (Frida).
The participants highlighted that many transferable clinical skills they developed during training occurred within these types of highly specialised placements, which provided them with an insight into environments which were challenging in similar ways to CAMHS, and exposed them to the types of families they would go on to work with clinically as NQCPs.
This sub-ordinate theme has brought to light the views across the interviews of how clinical training was beneficial to participants, and how they drew upon these useful experiences in this challenging, transitional period of their careers. It provided evidence that participants’ training experiences helped mediate their transition, as well as giving many participants a feeling of growth in their ability to manage the challenges of their roles. Participants’ training placements were relevant to their NQCP posts, and provided them with valuable experience in managing stress, while a pertinent focus on team dynamics was of great benefit in the taxing contexts of CAMHS MDTs.
3.6 Acknowledging and Desiring Ongoing Development