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Eye on Psi Chi: Fall 2010
What the Doctor Ordered: Creating a Career Path in Clinical Psychology That Fits You
Kathryn A. Sanders, PhD, Yale University School of Medicine (CT)

My colleagues frequent ask me to speak to undergraduate psychology students about my career. The hope of my colleagues is that I will inspire their students to pursue a career in clinical psychology. Over the years I have found that my goal is not to convince all students that clinical psychology is the best career for them, but to encourage students to find a career that enriches their lives. One that challenges them, ignites their passion, and gives their lives great meaning. This article is addressed to students who are wondering…Is clinical psychology the right career for me?

There is plenty of information available about psychology careers. The American Psychological Association publishes an excellent book (Sternberg, 2006) and distributes reports about settings in which psychologists work, income data, and school loan debt (APA, 2005). Therefore, instead of boring you with statistics and definitions, I have chosen a more interesting road to travel and will describe what I am doing, how I got there. Along the way I will try to impart a few pearls of wisdom.

Reflecting back on my path, I see many points where I had no idea what I was getting myself into nor where I wanted to go. Through taking advantage of opportunities and being open to trying new things, I ended up in a place that is very rewarding. I believe that part of my success lies in my efforts to use my values as a guide when making career decisions. Although 10 years ago I could never have predicted that I would be at a Veterans Affairs (VA) Hospital, working in primary care, and running a training program, it makes sense when viewed through the lens of the things that are most important to me in life. I enjoy feeling that I am contributing to something larger than myself, listening to others' stories, and teaching people new skills. I value my personal relationships, sharing knowledge, and caring for others. I enjoy my career because it incorporates the things I value. Part of what I want to encourage you to think about as I describe what I do, is what you want your life to be about and consider whether something like this would match your own goals and values.

What Does a Clinical Psychologist Do Anyway? Beyond Head Shrinking, Mind Reading, and Freud
Clinical psychologists work in a variety of settings and engage in a vast array of activities. I work as a Clinical Health Psychologist in a VA hospital. The VA is a nationwide healthcare system designed to meet the unique healthcare needs of military Veterans. The VA hospital where I work includes several outpatient medical clinics, medical and psychiatric emergency rooms, and inpatient medical and psychiatric units. I organize my work into five categories: clinical work, supervision and teaching, program development and evaluation, research, and administrative and committee work.

My main clinical responsibility is as the behavioral health provider for our integrated mental health-primary care program. I work collaboratively with primary care providers (PCPs) to address the mental and behavioral health care needs of their patients with the goal of improving access and reducing stigma associated with mental health treatment. I assist patients experiencing symptoms of depression, anxiety, or posttraumatic stress disorder; help patients improve their adherence to medical treatment or coping with chronic illness; and coach them in stress management, problem-solving, and other skills.

As director of training for our postdoctoral residency, and health psychology track coordinator for our internship program, I provide a lot of supervision. We have three interns, three postdoctoral residents, and one practicum student every year. This translates into several hours per week of one-on-one and group clinical supervision, mentoring of students working on research and program development projects, and lecturing in our various seminar series. I also supervise psychiatry residents and psychology interns training at Yale School of Medicine as part of my academic appointment there. In addition to working with psychology and psychiatry trainees, I regularly lecture in the internal medicine seminar series; give workshops and training sessions to nurses, social workers, and PCPs and staff; and travel to undergraduate colleges to give guest lectures on various topics.

As psychologists, and therefore as scientists, it is our duty to evaluate the interventions and programs we offer. I am involved in several projects examining the programs we offer trainees and patients and participate in a regional committee charged with measurement of patient outcomes in integrated primary care programs in our network.

I was trained in a scientist-practitioner model emphasizing the integration of scientific research and clinical activities. The VA's Health Services Research and Development service recently awarded me a pilot grant to examine minimal contact treatments for Irritable Bowel Syndrome. I have been involved in several research projects being conducted by another psychologist at the VA and am also conducting a chart review study looking at health-related variables in Veterans returning from Iraq and Afghanistan.

Finally, no psychologist can avoid administrative and committee work. I serve on our hospital's polytrauma team, primary care pain management workgroup and peer support group, high risk pain medication task force, and am our team leader for our integrated primary care team. This work can be more fun that you might think and is important in terms of making connections with staff from other hospital services.

These are a lot of different types of responsibilities. Most psychologists will have multiple roles but the amount of time devoted to each will vary. In our VA, there are some psychologists who do mainly clinical work, some who are devoted entirely to research, and some like me, doing teaching, clinical work, and research. I was hired primarily to provide clinical services. Then, as people got to know me, they started asking me to be on committees or take on other leadership roles. This has evolved to my current constellation of responsibilities, and I am sure it will continue to change.

There has been a constant give-and-take in the 3 years I have been at the VA, and it has not always been fun or worked out the way I would have liked. It is not that I could not decide what I wanted to do so I chose to do everything. Every one of these responsibilities ties in with my values. I strongly believe that because I received excellent training to become a psychologist, part of my duty to my profession is to participate in the training of the next generation of psychologists. My clinical work allows me the opportunity to help Veterans optimize their health and wellness. Serving on committees allows me to develop relationships with staff in all departments of the hospital. This creates a network of people I can ask for assistance in completing the responsibilities of my job and has led to many friendships. For me, it is not about coming in every day and pushing papers or getting patients in and out. Work is a way to contribute to the "greater good," a way to enjoy human connections, solve problems, and have some fun.

A Day in the Life of…
I hope you are starting to get some ideas about how to create a job that fits you. Now I will describe a somewhat typical day so you can see what it is like to live in my shoes. Look for the different categories of tasks I mentioned: clinical work, supervision and teaching, program development and evaluation, research, and administrative and committee work. I want you to notice how these activities are not mutually exclusive, they build on each other.

My day may start with a primary care team meeting. Staff are frustrated because of increasing work load. They ask me to start providing lunchtime relaxation sessions to help them unwind. Rather than doing it by myself, however, this is a great opportunity for the psychology interns under my supervision to build skills teaching other professionals and a way for us to support our medical colleagues, so I agree to get something started.

Next, I have clinical supervision with a trainee, during which another trainee pages me because her patient came to his appointment intoxicated, and she needs help getting him to the emergency room. The patient denies that he has been drinking and is refusing to cooperate, yet we cannot let him drive himself home in an inebriated state. This is a great opportunity to model for the student how to remain calm and de-escalate a difficult situation.

Then I have a short clinic where I see four patients in 2 hours. I see the following patients that morning: First, I have a diabetic patient who was nonadherent with his medical regimen. After several months, he is taking his insulin regularly and walking several times a week. The patient and his provider are excited by these positive changes.

Next, is an 80-year-old bereaved man who told his PCP he just wants to die and be with his wife. His provider is worried that he may try to kill himself. The patient is not suicidal but we spend some time talking about his deceased wife, normal grieving, and some things that other patients have found helpful when they've lost their loved ones. We make an appointment to follow up in a week.

The third patient is an anxious gentleman with high blood pressure. He has been taking multiple blood pressure readings per day and is very concerned that his blood pressure varies so much. His provider has tried to reassure him that such fluctuations in blood pressure are normal and encourage less monitoring. Paradoxically, his provider believes that this patient's excessive worrying is the cause of his high blood pressure. I taught him a quick relaxation exercise and will see him again to work on reducing his health-related anxiety.

Finally, I see a patient who wants to know how to cope with her father who needs nursing home placement but is refusing to go. We spend some time exploring options and develop a plan to discuss her concerns with her family and her father's primary care physician.

After clinic, I go to a meeting of the primary care pain management peer support group. Their first few meetings did not go well, and I was asked to train them in communication and meeting management skills. I return to my office to work on some paperwork to submit to the Institutional Review Board for a research project tracking patient flow and clinic utilization in our new integrated mental health-primary care program. I'm interrupted by a physician who wants to role-play how to talk to a patient about sleep rules for insomnia. I finish the day working with one of my postdocs on the layout for a poster we are presenting at a conference.

Food for Thought
This is clearly a lot for one day, but I assure you it is fairly typical. An important thing to consider at this point is, how does a day like this affect me? My perspective might help you answer the question: Can I see myself doing this? There are some things to consider about this type of work.

You need to have a lot of energy to do this type of work. You also need to have balance: things you do outside of work. You have heard the expression "work hard, play hard." There is truth in that.

The more different types of tasks you have (i.e., teaching, clinical work, research), the more directions you are going to be pulled. You must be good at staying organized, prioritizing, and switching from one thing to another. I am constantly interrupted at work and have developed strategies for improving my efficiency despite this. For example, I keep a running to-do list to track the tasks I am working on and use reminders, my calendar, and shared documents on my smartphone to help me remember important deadlines, meetings, and tasks. I also try to tackle tasks that need more focused attention early in the morning before the students start their day and interruptions become more likely.

It is hard hearing about other people's pain. I hear some horrific things, and I would be lying if I said it does not bother me. When I meet patients who are bereaved, it breaks my heart. When I work with patients who are dying, it reminds me of my own mortality, and I think about what would happen if I was diagnosed with a terminal illness. It is important to think about whether you want to expose yourself to these types of experiences.

I also work with patients who are doing well overall and just need a little boost. With these patients, you get to build on their strengths. Hearing about struggles they have overcome and seeing their motivation to continue to improve themselves is inspiring.

I see these issues as the challenges of a job like mine, but also the joys. My dedication to my work reminds me of the importance of dedication to my family and life outside of work. Hearing about others' pain helps me to focus less on my own. Learning of others' resilience encourages me to be resilient. Being reminded of death helps keep things in perspective. These are lessons that guide me toward an authentic life. One that is thoughtful and active, not just passively letting the days slip by, waiting for retirement.

Pearls of Wisdom From a Fellow Traveler
If you are thinking that a career in clinical or counseling psychology may be right for you, I would like to give you my thoughts on what it takes to be able to do what I do as a psychologist, as well as some general advice no matter what path you choose to take. First, to be able to play a role, no matter how small, in helping people find wellness or happiness is very meaningful. But, do not become a psychologist just because you want to help people. There are plenty of ways of doing that without going through at least five more years of school!

Psychology is a science, it is not touchy-feely. You need to spend a lot of time learning how to help people. This includes learning how humans operate by studying biology, neurology, learning theory, cognition, and human development. You need to be prepared to work and study hard. You need to be smart. You need to be a scholar before you can be a healer.

When building any career, be strategic but do not overplan. Take the advice, "don't sweat the small stuff" to heart. Have a goal in mind and a general idea how you would like to get there, but do not plan every turn of the path. Sometimes a detour leads to opportunities that you did not even know about. Getting lost has been the way I have found most of my favorite restaurants! If you approach things with open-mindedness and flexibility, opportunities will come to you. You just need to keep an eye out for them and take advantage when they come your way.

You can also work to create opportunities. A strategy I have used is to make myself invaluable wherever I am. If you do this right, people cannot imagine getting along without you. If an opportunity arises, they will offer it to you. Additionally, they will create opportunities for you to entice you to stick around and keep doing the wonderful things you are doing for them.

Be productive. You have to work hard and get good grades. People need to be able to see the outcome of the work you have done. In college, grades are one of the most important ways you can demonstrate what you can accomplish.

Get involved. Join professional organizations, go to conferences, even if you do not know anyone there. Join clubs or groups at your school that reflect who you are and what is important to you. Think of all the marketable skills you can develop when part of a group: organizational skills, ability to work well with others, and so on.

Seek mentorship. Find someone you admire, who has characteristics you would like to develop in yourself, someone who is doing the job you would like to have. Ask them questions, lots of them. Mentors can teach you the skills you will need to succeed, help you network and find jobs, and guide you along a path that works for you. You can have more than one.

Finally, be happy, be balanced, and be authentic. Live in a way that you find meaningful. Never compromise your character or your values for a job. Find things that you enjoy and do them often! Find friends who will help you with this, because it is hard to do it on your own.

Parting Thoughts
I am just one example of what you can do with a doctorate in clinical psychology. You need to talk to other people in the field, learn about their experiences. Find out what their days are like. There are as many unique jobs as there are psychologists. Chances are, you can find something that fits your interests. This is important. You will spend the majority of your adult waking life at work. You need to consider how you want to spend the majority of your time. I know that for myself, I did not want to end up like so many adults in my life—miserable at their jobs. I cannot say I love my job all the time or that I love every aspect of it, but for the most part, I enjoy what I do and feel fortunate to be where I am. Hopefully, with a little effort and using the advice from me and others, you can find something that fits you. Good luck!

References
American Psychological Association (2005). Report of the 2005 presidential task force on evidence-based practice. Retrieved August 13, 2010 from http://www.apa.org/practice/resources/evidence/evidence-based-report.pdf

Sternberg, R.J. (Ed.) (2006). Career paths in psychology: Where your degree can take you (2nd Ed.). Washington, DC: American Psychological Association.


Kathryn A. Sanders, PhD, completed her doctorate in clinical psychology at University at Albany, SUNY. She is currently the director of the Health Psychology Section at VA Connecticut Healthcare System's West Haven campus and runs their Clinical Health Psychology Postdoctoral Residency and Health Psychology Internship Track. She works as lead clinician in the Integrated Mental Health-Primary Care program and has research interests in the area of integrated primary care and minimal contact interventions for health conditions such as irritable bowel syndrome and chronic pain. She is also an assistant professor at Yale University School of Medicine.

Copyright 2010 (Volume 15, Issue 1) by Psi Chi, the International Honor Society in Psychology



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Eye on Psi Chi is a magazine designed to keep members and alumni up-to-date with all the latest information about Psi Chi’s programs, awards, and chapter activities. It features informative articles about careers, graduate school admission, chapter ideas, personal development, the various fields of psychology, and important issues related to our discipline.

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