Clinical Psychologist Recruitment Crisis in Pain Services.
Webinar Blog and Q&A summary, 24 Feb 12:30-13:45
Connect Health “Change” brings you the ninth in a series of webinars to make and embed transformation in healthcare. Aimed at system leaders and clinicians across the NHS, the webinars provide practical solutions to the challenging issues we are all grappling with.
Historically, it has been a challenge to recruit psychologists to work within interdisciplinary pain services. The current shortage of qualified clinical psychologists across the UK has further exacerbated this problem. The purpose of this webinar is therefore to raise the profile of pain amongst prospective trainee psychologists, and trainee and qualified psychologists by answering two questions:
- Why work as a clinical psychologist in the field of pain?
- What does it involve?
Delegate feedback
- Pacing and timing was excellent. Content provided was detailed and informative without being overwhelming.
- Hearing someone’s personal journey living with persistent pain was really profound!
- Range of discussions and involvement of a person who has experienced chronic pain.
- I was hoping for more discussions around the challenges of recruitment and working in this area. I felt the webinar was highly positive and encouraging.
- Despite frequent mention of clinical psychologists, it was unclear if the webinar was aimed at solely recruiting clinical psychologists or whether discussions were relevant for other applied psychologists (i.e. Counselling psychs) interested in working in chronic pain.
Watch the Webinar in Full
Q&A
Chaired by:
Gail Sowden, National Lead for Pain, Connect Health and Chair of a British Pain Society SIG – introduction from the Chair
Question: Is the recruitment crisis in pain management unique to the recruitment of clinical psychologists or is there an interest in recruiting applied psychologists with the appropriate therapeutic skills and competencies?
Answer: Pain services value having different professional disciplines and can and do employ different types of psychological therapists, in addition to clinical psychologists. We don’t tend to have as much difficulty recruiting other types of applied psychologists or CBT therapists but there is a current shortage of clinical psychologists, so that is why the focus of this webinar is specifically about clinical psychologists.
Dr Tess Maguire, Clinical Psychologist and Clinical Tutor for the Doctorate in Clinical Psychology at the University of Southampton, Clinical Director.
Question 1: What opportunities might there be for experiences of pain services during clinical training?
Answer: All courses differ slightly in what they offer, I can talk a little bit about our training course at Southampton. We incorporate health placements within our six-month core placements in our first year, so that does include placements in chronic pain clinics.
We also have a final nine-month placement in our third year where we collaborate with trainees to decide what would meet their training needs and interests and they get some choice as to where they’re placed. There’s an option of a nine-month final placement working in pain services. In addition, our third years have a small, allocated pot of money for specialist training so they can decide what they’d like to spend this on. They may choose to spend it on specialist health, pain related training or master classes like ACT or Contextual CBT. We have lectures in health psychology and pain, there’s also opportunities to link with pain services to undertake audit and thesis work – I know this because I did my training at Southampton and I completed my final thesis on sense of self and chronic pain, which was a really interesting insight into working in pain.
I’d expect that other courses would have really similar opportunities available, so if you’re thinking of applying or if you’re on a clinical training course and you’re interested in experiencing pain services, go and talk to the course team about any opportunities they may have available. Similarly, if you’re working in pain services and you’re interested in contributing to teaching, supervision, research or audit please do get in contact with your local course.
Question 2: What books or papers would you suggest having a read of?
Answer: Lance probably isn’t going to blow his own trumpet – but I have to say his books on and his writings on Contextual CBT and ACT-based approaches to pain are fascinating and readable. They bridge the kind of clinical applications with the research and theory really nicely.
Nikki Ellis, Patient Champion, Wolverhampton Pain Service – With lived experience of pain, Nikki will talk about her experience and the role of clinical psychologists.
Question 1: What do you think are the most important skills for psychologists to have when providing or working with somebody with pain?
Answer: The main thing I was searching for when struck with persistent pain was support and understanding; you’d be surprised actually how little of that I found. I came across numerous doctors (particularly neurologists) that didn’t take me seriously and they were insisting I was too young to be seriously ill, one even said to me that it was just a blip in my life that I would get over. When you’re dealing with such a life-changing situation and you’re getting no answers and then on top of that you’re being dismissed it’s a lot to have to take mentally and it’s really hard to keep going and keep persevering.
You start attending every appointment with a feeling of dread. There was a point in my journey where I stopped going to the doctor, even when I had new symptoms, because I didn’t see the point. I was so fed up of being pushed aside and misunderstood. I know from my own experience and from speaking with the other pain patients on a regular basis the main thing we want is for someone to listen – and I mean actively listening – not just for facts and statistics, or things you can take off a list. But for thoughts, emotions and letting them feel comfortable enough to open up, letting them tell their stories without rushing them or cutting them off and show that you’re really taking it in.
Be encouraging, have open body language, make eye contact. Human connection is vitally important, especially to someone who already feels so isolated from society. It’s also important to be non-judgmental, like I said the vast majority of pain patients spend so much time judging themselves and worrying about how others perceive them. What they need is actually for someone to look at them with compassion and with no preconceptions which as humans, we automatically do that. It can be difficult, but that’s what they need, for someone to validate them and show that they matter. It’s a long journey, living with persistent pain and it never ends, even now, in the position that I’m in. I’m not at the end of my journey it will be for the foreseeable – so it’s important that patients don’t feel forgotten, that’s a huge thing. So it sounds simple but basically pain patients – just want someone to care, and to listen.
Question 2: How long has it taken you to get to where you are in your journey?
Answer: It is a long, long journey. I started with my pain just over 12 years ago and it took six years for any sort of diagnosis, at which point I’d got a lot worse, and then I think the pain management programme I did was about 2015. I often say to patients, that at the point I did my pain management programne, I wasn’t fully ready to make changes. I don’t think I’d accepted my situation, I’d only recently been diagnosed, but I remembered the things that I’d learned, and I started to gradually apply them over the years. I made changes in my life like setting up in my own house – because I relied on my dad a lot previous to that -and starting a hobby, you know all these small changes over a long period of time.
I’ve noticed, loving myself for who I am and appreciating everything I have in my life has really came over the last two or three years. It took me 10 years – which sounds crazy, but everybody’s circumstances are different. I didn’t have a lot of help, it took a long time for me to get the help that I needed and it’s only since I had that, that I have been able to get to where I am. It’s really just about getting the help that’s needed as soon as possible.
Dr Lizzie Doherr, Clinical Psychologist, Lincolnshire Pain Management Service, Connect Health – A day in the life of a pain psychologist
Question 1: What do you see are some of the main similarities and differences between working in a persistent pain service as compared to your previous role in a neuro rehab team?
Answer: I think there are many similarities, the skill set essentially is very similar and working as part of the team is similar, as well as having a value-based ethos of working. I think that some of the differences for me is, it’s how much you’re involved with working alongside that interdisciplinary team, so really being immersed in it. In my previous role we would do joint appointments, and some of the groups that we ran we would have other clinicians coming in to run alongside us. But, actually spending eight weeks delivering an intensive pain management programme alongside a colleague is such a brilliant opportunity to really get to know them, their work, the background, the profession and to bounce off each other.
I might be explaining something that I think is landing well and then a colleague in the room can pick up something that maybe hasn’t quite been understood or hasn’t quite been landed in the way I intended and equally I can do that for them. Therefore, true interdisciplinary working is one of the things that for me, has felt quite different, and has felt really valuable. I feel I’ve really grown in my understanding of myself but also in terms of understanding from other disciplines as well. That’s probably the depth of the interdisciplinary working alongside the joy and seeing how much this can change people. As Nikki previously said, seeing people grow in eight weeks on this amazing journey, that really changes how they feel about themselves, their life, their pains, their relationships is really wonderful.
Question 2: Lizzie, when you moved services were there any particular things that you found useful?
Answer: Yes, there certainly were. I was directed to the ‘Living Beyond Your Pain’ book, which was actually really valuable reading. It was interesting because when I made the switch, part of what really excited me, was I could see how the ideas within ACT could really apply to pain, although I hadn’t really thought about that before. I’ve been using the ideas behind ACT, to help people live well with their neuro conditions and so reading that book was brilliant, because I could really see how to use the concept within a population of people who were living with persistent pain.
If I am completely honest, before reading that, I think I was nervous about working with people who’ve lived with pain for a very long time. So, really understanding that within ACT, this is about changing your relationship to the pain, it’s about finding ways to head towards what you value alongside your pain – that really excited me to see how that can work clinically.
I would say to anybody thinking of changing from one specialism to another, that this is about helping people to make some changes in their life, that are going to improve their life, then we can use the skills we’ve learned in all different areas to help with that process. Ultimately, one of the key parts of it for me is creating that kind of therapeutic alliance of warmth, and compassion. As well, I think Nikki mentioned the non-judgment and understanding and validating that allows somebody to then experiment with other ways that they can relate to things. Those core skills are all there, but I would say that book did help me with my confidence in how to take these ideas forward with a population of people with pain.
Question 3: Is there a risk for psychologists or therapists, for example to feel socially isolated from other clinical psychologists or therapists or if anyone is working within a small service, what could be done for them to feel connected and supported with their fellow psychologists?
Answer: If we’re thinking about within our service, the ACT as a model is threaded through the whole service. That includes the colleagues and ourselves as humans. I think that ability to connect is really important and creating opportunities to be able to do that with other people is really key. I would also say it’s broader than just the psychologist. When you’re working with people with persistent pain whether you’re a psychologist, nurse, OT, or physio it can be really difficult.
Often people are really desperate for some help and feeling distressed by their pain and the effects of it, listening to that is tricky whether you’re a psychologist, physio, or a GP etc. Having an opportunity to come together, to talk and to support each other is really crucial. It is also thinking about how we manage the difficult feelings within us, that can come up, so I think it’s really crucial to connect with other psychologists within a pain service. The service I’m currently in, just connecting with other colleagues is really important and I feel very well supported by the entire team. I did feel like that in other teams, but I think there’s something about a pain service, where for me it’s just incredibly supportive.
Question 4: How has the switch to virtual/digital gone down with all your patients. Is there a large cohort that have been left behind?
For us there have been a cohort of people who could not engage with our virtual PMP offer, and are awaiting face to face group work, partly due to personal preference and a desire to get the most out of the PMP, and partly due to not having the ability to access virtual resources. However, for many patients they have really embraced the video resources. They have appreciated being able to share them with relatives and friends, and to go back to them multiple times to consolidate learning and have been able to make big changes to support their wellbeing. I have personally been amazed at how well they have worked for some people. My clinical hunch is that this way of learning has really suited some people and really not suited others, as is the case for all formats really. Going forward, being able to provide a mix of approaches based on individual need is a really exciting prospect.
Question 5: Have you seen any unintended consequences, positive or negative, as a result of not being able to see people face to face?
I have been surprised at how much can be achieved over the telephone! My ability to creatively describe metaphors for example has been honed during this time, as well as my ability to use patient’s own interests and language to create bespoke metaphors for them to help them engage in the concepts. For me the biggest drawback of not being face to face is that it has been a challenge to help some of our most distressed patients to feel soothed in the sense of being able to co-regulate together. I find this much harder to achieve over the phone when so many of the soothing cues are not able to be present.
Question 6: Is the recruitment crisis in pain management unique to the recruitment of clinical psychologists or is there an interest in recruiting applied psychologists with the appropriate therapeutic skills and competencies?
We are looking for any applied psychologist who has the appropriate therapeutic skills and understanding of the speciality. In my opinion a broader range of skills and backgrounds can be very advantageous for the service and the team.
Prof Lance McCracken, Professor of Clinical Psychology, and Head of the Division of Clinical Psychology, at Uppsala University in Sweden.
Question 1: What would you say to someone who feels that specialising in pain means they will never be able to work in another area, that it will limit their future opportunities?
Answer: The first thing I can say is that’s a very common fear that I’ve heard voiced many times. I’ve worked in managing services for more than 25 years and I’ve recruited a lot of psychologists who were considering entering into pain management as a specialty area, perhaps from another area. I can understand the overriding concern, but I think there’s several things to say about that.
Firstly, anything you specialise in will come with a cost, but it’s probably not the cost that you think. People perceive specialisation as a letting go of general skills, or they look at it as a narrowing of that skill set. I agree the perception is there, but I dispute the reality of this notion that specialism is a trade-off, so there’s a cost in perception but what there isn’t I would say is a cost in a trade-off of skills. The more you get better in a specialty area, like pain, I think the more you have general skills that you can apply anywhere. If you work in pain it will teach you so many skills that you can use in so many areas again. I dare you to try it and see if I’m wrong!
Question 2: When we’re thinking about conducting research in the field of pain psychology, what do you feel are the key questions that still remain to be explored?
Answer: We could have a whole other webinar on this for several days! It is a really relevant question, let me hit a few highlights. A lot of what we know today is based on group data and group delivery, so one of my issues that I’ve come to in the last several years, is I think a key question. What about the individual, how can we understand individual need? I believe we will increasingly find there is a gap in our knowledge between the things that we have learned in group data and the processes that we believe are key or important and what we actually need in knowledge to help every single individual get a good result. I think that’s only going to come from using what’s called more idiographic approaches, more individually based data gathering, lots of data over time, instead of just data before and after treatment in a group.
With that, we will answer this other question related to how to individualise. The question is; which processes are the processes of change that really carry the impact? Let’s assemble our list of empirically supported mechanisms of change.
Question 3: What books or papers would you suggest somebody has a read of?
Answer: I would add two books that are my personal favourites. I would read ‘A Liberated Mind by Steven Hayes’ if you just want to take the psychological flexibility model on as a human being. It’s a clear and inspired full length description of ‘what is psychological flexibility?’ The second to add, if you’re a little bit geeky and want a little bit more of an advanced read; I found a lot of value in ‘Mastering the Clinical Conversation by Matthew Velate, Jennifer Velate and Steven Hayes’. If you’ve got the introductory level, and you want something to challenge you a bit more I’d go for ‘Mastering the Clinical Conversation’.
Question 4: What are the similarities and differences between pain services and other health services? How is it similar and different to other physical health specialities? Example: Diabetes.
Answer: I have a perception, and that is pain services tend to be more integrated with different professionals. I don’t have any data on this, but I think if you get pain services, you’ll often have the full interdisciplinary team working together more frequently, as a working model. Whereas other specialty areas in medicine, like diabetes, neurology or oncology, you are more likely to have a couple of psychologists working as a single, or a pair in another medical specialty. It’s a little bit less integrated and that might be a mistaken impression, but that seems to be what I’ve seen.
Question 5: How has the switch to virtual/digital gone down with all your patients. is there a large cohort that have been left behind?
First, we have done a survey of people with chronic pain in the UK during the pandemic and we know that they report that their treatment for pain has been negatively impacted by it. Indeed, some people have been “left behind” as implied here. At the same time others have been surprised by how much it can help to attend services remotely, this includes both people with chronic pain and treatment providers.
Question 6: Have you seen any unintended consequences, positive or negative, as a result of not being able to see people face to face?
Two unanticipated consequences of COVID-19 are, first, that people have been forced to use the internet and remote delivery mechanisms and now they will use them more in the future. Second, a lesson learned is that we need to develop and maintain easier to access and more flexible modes of delivery for the future so that we will not find ourselves in circumstances such as we have now, so that we will be prepared with better developed online and remote treatments that are equally as good or perhaps, in the future, better than face to face in real life.
Question 7: What does referral criteria look like in CP pain services?
The simplest answer to this is that an appropriate referral will be (a) a person with chronic pain (> 3 months), (b) significant impacts on functioning, the (c) ability and potential to benefit, and (d) agreement with the format, methods, and goals of treatment. Each of these points can be expanded or might be framed slightly differently by different services. In a nutshell: appropriate, potentially beneficial, safe, and agreed.
Watch the webinar again, which includes further insight from the speakers including a full Q&A session, and read more about the speakers here:
Wednesday 24 February 2021
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