The Worst Advice I’ve Been Given as a Clinical Psychologist

Last week we looked at the best advice I've been given in my time as a clinical psychologist. But that advice has been balanced with some things that I don't feel are as helpful, so here are my thoughts on the worst advice I've been given as a clinical psychologist.

There have been a few pieces of advice that I haven't necessarily agreed with as I've gone through my career. I do believe that most of the advice I've been given has been well-meaning, and people have genuinely felt that their advice was coming from a good place; However, I think that a blanket approach to some of that advice could be quite damaging. To be fair, a blanket approach to most pieces of advice would be damaging, but you'll understand what I mean as you read on.

Don't touch your patients

This is a big one for me, and one I continue to grapple with if I'm honest. When I was training, I was told by a very well-respected psychologist that I should never touch my patients, under any circumstances. That psychologist saw all physical contact (hugs, handshakes, patting on the shoulder, even extending to handing someone a tissue) as potentially detrimental to the therapeutic relationship, and therefore to the therapy itself. I understand the point, but I have to disagree.

There are absolutely situations where physical contact between a patient and therapist should not exist, and to be honest I would probably extend that to "most situations". There are often dynamics at play that we might not always be aware of, and I've never been overly keen on hugging people within the context of the therapy relationship. If it happened every session, we'd be talking about it within therapy. But working in physical health, especially with people who might have just been diagnosed with life-threatening conditions, a hand on the shoulder can be comforting. Holding someone's hand at the end of their life can be transformative. Additionally, if you work with children you don't always get the option of carefully discussing boundaries before they fling themselves at you at the end of therapy! I don't believe that a blanket ban on physical contact is helpful for either patients or therapists (but I do believe that it is something that needs to be taken to supervision and thought about very carefully if possible).

Don't challenge the status quo

For a lot of my training and all of my post-training career, I have worked in hospitals. I love working in hospitals; they are magical, frightening, hopeful places where many things can go wrong and anything is possible. But working in hospitals also means working with medical doctors, and that is where I first heard this piece of advice.

Now, I see an integral part of my job as challenging the status quo. I think that we do some things really well in healthcare but I also think that not challenging things leads to some really bad things happening. The person who gave me this advice was a fairly senior psychologist, and I understand that it can be hard to "rock the boat" when you get on well with your colleagues and your job depends on people coming to you for help with difficult situations. But whether we like it or not, the hierarchy of power in hospitals is still dominated by medical doctors who may not always be the best people to make decisions about someone's psychological well-being, and nurses who often feel as though they can't challenge decisions that are made (and therefore inadvertently reinforce the power dynamic). For example, I have worked in situations where a nurse would bring a doctor his lunch every week - a specific sandwich from a specific shop. I'm sure he paid for it, but she had to go out of her way to do that and would get anxious if they didn't have the sandwich he wanted. That nurse would also see patients for the doctors if they didn't turn up for clinic on time - and I watched the doctors turn up later and later over time because they were happy to let her see their patients as well as her own. I've also worked in situations where doctors would vape in the office (not allowed) and nobody would challenge them on it. That's not a "status quo" that I want to be part of, and I'm going to try hard to challenge it where possible - to show my colleagues that they don't have to stand for things like that, and that it's not acceptable to treat people that way.

Use it as a learning experience

This is advice that has been given to me and many, many of my colleagues over the years - and when I mentor trainees, they still say it to me now! When things don't go so well, it's tempting to say "well, if nothing else it's a great learning experience." I think that's true to some extent, but it also feels very uncomfortable to me.

In almost every situation that this has been said to me, it's been within the context of a toxic working situation that has been toxic for a long time. Rather than continuing to send people into these situations and viewing them as "character building", I would rather consider why we think it's okay to allow those things to continue. Why we let trainees go on placements that have been complained about multiple times. Why we don't investigate work places where the staff turnover is ridiculously high, and actually deal with the problems top-down rather than expecting more junior staff to "manage upwards." People can learn incredibly well from positive experiences - most of the clear learning moments in my career have been in situations where I have seen someone respond in a way that I want to learn how to copy, rather than in a way that I want to avoid. We don't have to break trainees or teach them "how things really are" - we can change the environment rather than trying to force them to adapt to the same rubbish situations we had to.

This is a particular bee in my bonnet because I have seen confident, competent clinicians question their judgement to the point where they lose faith in their own abilities - and that, to me, is a real loss for both patients and workplaces. By all means, reflect on the fact that this situation shows you how you don't want to be managed, or how you don't want to work with others - but know that until we face the problems head-on, you can't truly know that any situation you go into won't be yet another "learning experience." I think this links to my "don't challenge the status quo" point from above, as I would put money on both of those things being said by the same people. Ultimately, we need to protect and nurture trainees and early-career clinicians from every discipline, so that we don't replicate the toxic environments others have experienced. This is always something I'm mindful of as I move into "experienced clinician" territory, and I ask the people around me to tell me if I seem like I'm getting jaded, or behaving in a way that replicates those old patterns. As long as we're aware of it, we can stop it from happening again.

So there you have it - the worst advice I've been given as a clinical psychologist. Probably a more ranty blog post than usual, but it can't be all puppies and rainbows all the time on here! Let me know what terrible advice you've received in the comments.