Case studies: Counselling psychologist: Patrick

Patrick works for the National Health Service (NHS) in an improving access to psychological therapies (IAPT) service. He studied psychology for his first degree, and after working in NHS mental health services, decided to qualify as a counselling psychologist by undertaking a professional Doctorate (PsychD) at the University of Roehampton in 2010. His work focuses primarily on providing assessments, onward referrals and psychological therapy to a variety of clients. 

I initially studied psychology and eventually started working in the NHS with clients who had severe and enduring mental health difficulties. This is where my research interests developed, which followed with me when I applied for counselling psychology training. What I like about counselling psychology is its focus on therapeutic approaches combined with a psychological knowledge base.

Immediately after completing my training, I was offered a job working in a private sector primary care service and completed the British Association for Behavioural and Cognitive Psychotherapies (BABCP) accredited cognitive behavioural therapy (CBT) training. This was a radically different experience from counselling psychology training as it narrowly focused on CBT. I found my counselling psychology training and the critical thinking it offered me to be invaluable, as was the independence and emphasis on self-management that the training had fostered.

Towards the end of my CBT training, I was offered a counselling psychology post with an inner London mental health trust, which is where I am now. This post really opened my eyes to the level of complexity that psychologists have to work with in primary care and what an asset counselling psychology's very wide theoretical base is in this work.

I see over 20 clients per week in my service, so it can be very challenging and intensive work. Working in primary care means that you are often the ‘port of call’ for a wide range of mental health difficulties and levels of severity and initial assessment is key to the client gaining the most appropriate support. Typical client presentations include anxiety (OCD, panic disorder, GAD, PTSD, health anxiety, phobias, etc.), depression, health-related concerns and behaviours, and interpersonal difficulties. 

I provide two to three assessments per week and either place these individuals on the waiting list or liaise with other services for onward referral. I spend my time working in the community (usually GP surgeries) or at our main office. In the GP surgeries, I am the only allocated psychologist, so I consult on particular cases and manage all the referrals that come through. I like working with the diversity of what we are presented with in primary care, though there is also the potential to specialise. 

The team I work with is made up of other practitioner psychologists, CBT therapists, psychological wellbeing practitioners, psychotherapists and trainee psychologists - it is a good blend. I also supervise a psychological wellbeing practitioner weekly.

The job is very administration-heavy, so you really need to be organised in order to keep up with all the duties involved in the job.

Since completing my counselling psychology training, I have settled into primary care psychology and this is where I see my future. I would like to do more research and develop a specialisation in primary care mental health. I would also like to develop my supervision skills, which I hope to do in a new post that I have recently been offered.

I would advise trainees to experience different types of placements and to look for a specialised placement in their final year, such as trauma or personality disorders. I would also advise trainees not to be afraid of research and to get as involved as possible in writing and producing publishable material; practitioner research can only help clients, services and the NHS.