Solidarity, stress, and support: A reflection on PWP training during a pandemic

Anne (not her real name) started as a trainee PWP in September 2020. Having spent three years at university writing essays about 18th century poetry and studying foreign languages, she decided to shake things up a bit and did a Masters degree in Psychology. When not at work, Anne likes making blankets and assorted snuggly items, drinking copious amounts of tea, and hoarding notebooks she will never use. Being a trainee PWP is her first job following her Masters degree.

As it comes to sitting down and writing this post, I am immensely glad that I keep a diary. Aside from the usual benefits of getting things out of your head and down onto paper, it has reminded me of experiences and reflections from the first few months of being a trainee PWP that would otherwise have been lost in all the usual noise of a new job. It is bittersweet to read back over the last six months. In truth, starting this job has been far from what I imagined when I applied back in the Spring, and doing it all during a pandemic has added a very particular flavour to the whole experience. Trying to distil everything down into one linear narrative is a bit like trying to get a kite to stay still in a gale-force storm, but I will do my best!

Before launching in though, a few things to note. Firstly, as almost goes without saying (but say it I will), I speak only for myself. The experiences I have had over the last few months, and how I feel about them, will be different from colleagues within the same service, let alone those employed by other Trusts around the country. That being said, I do hope that those reading this who also work in an IAPT service may find a glint of commonality or recognition in some of these ramblings. Secondly, I will be referring to those who access our service as clients. I know there are discrepancies and disagreements in mental health services about terminology – clients vs. patients vs. service users, for example – but this is the preferred word within my service, and for the sake of consistency it is the one I will use here. I am aware that not everyone agrees with this, and no offense is meant. Perhaps the use of language will have to be another post…!

It’s important to talk about confidentiality. There will be times in this post where the best way of illustrating something will be with an example. In these instances, everything is of course anonymised, and information changed enough to avoid recognition. Ordinarily I would not share any examples of this nature, but with these precautions, including my own anonymity, I believe they serve a necessary purpose.

I will start with the negatives- but to make up for it, there’s a cute picture of my kitten climbing the curtains on the other side!

This job is hard. As has been said before, PWPs are often at the front line for triaging those who are seeking support, and the word ‘trainee’ in the job title is not the shield I thought it might be for who we are allocated to assess. I have worked with people with eating disorders, people who are experiencing hallucinations, and those who can’t leave the house due to debilitating PTSD symptoms. On one occasion, I spent two hours on the phone with a new mother who had fled an abusive relationship and was actively suicidal, as well as having thoughts of drowning her baby. I spent a frantic day chasing up crisis teams and trying to get some support on the ground for her, terrified that if I didn’t act swiftly or well enough, two lives may be lost. The second example that comes to mind is when I was asked to assess an individual with an extensive history of extreme violence, whose notes from previous interactions with the service clearly outlined their challenging interpersonal skills. They made incredibly inappropriate and personal comments to me over the phone, and the details of past events that were shared resulted in several sleepless nights for me. I am aware that both of these cases were anomalies- clients who should have been more effectively screened before reaching someone just months into a job meant for working with ‘mild to moderate’ mental health difficulties. But being told that these cases were glitches didn’t take away the fear that I felt, the crushing sense that I was out of my depth and deeply unqualified for what I was being asked to do.

I may have made a mistake here…’

An important thing to note here is the response of the service. On both of these occasions, Duty Managers became involved immediately, and I wasn’t left alone to make the decisions about what happened next. In the case of the client who made such inappropriate and unsettling remarks, every Manager involved first asked me how I was and if I needed anything when they phoned, giving me the clear message that my own wellbeing in these situations was a priority for them. Working in IAPT has been eye-opening, in many ways, and one of the most frustrating has been seeing the cracks in the system. But everyone I have crossed paths with in this service genuinely cares about trying to alleviate the suffering of others, clients and colleagues alike. As frustrating and upsetting as those days were, I was touched by the human response. There was a recognition that we, as clinicians, are as vulnerable to fear and hurt as those we try to help, and it was ok to express that.

This being said, we were recently asked to increase the number of assessments we are doing each week, in order to cope with an influx of referrals into the service. When I mentioned quite significant concern about my own anxiety/stress levels to a senior member of staff, I was told that we all needed to ‘adapt’ to this increased demand, and to try and get some fresh air each day. Of course it’s important to recognise when things are done well, but there’s certainly some big holes when it comes to supporting TPWP wellbeing, especially when working remotely. 

Without doubt, the best part of starting as a trainee PWP has been my cohort. We are an unusually large group – there are more than 20 of us – and the nature of entirely remote learning means that there are many who I do not know beyond the compulsory ‘fun fact’ given in an introductory virtual meeting. If these are all true, there should be plentiful banana bread and cakes being shared around once we start working in the office! A group Whatsapp was set up in the first week, I suppose with the intention of getting to know each other. Perhaps unsurprisingly, this did not happen, as it is almost impossible to develop relationships with people you’ve never met in person through a group chat with 20+ people in it. However, it has become an incredible source of practical support:

‘I’m just doing my first crisis team referral, does anyone know what code needs to go in the top left box?’

‘ Could someone remind me where to find the guide for putting someone on the waiting list for the next OCD group?

‘Has anybody got any particularly good self-help materials for a client with health anxiety?’

I’m usually the first to put a group chat on mute (my introversion can’t stand constant pinging and endless chatter), but this one has been the exception. I have helped others when I know the answer to a query and have been helped by them in return, many times over. Nobody has ever suggested that something is a silly or basic question, as there is a genuine recognition that this job is tough at the best of times, let alone with a global pandemic to contend with. Reassurance is freely given, questions answered, and well wishes sent for good weekends and restful evenings. There’s even the occasional meme. For a group of almost strangers who have never met in person, I think there is something quite extraordinary about this.

3 – Support from colleagues is what has been keeping many of us afloat in these first few months

Additionally, I have formed a smaller group with 3 others in my cohort. It began pretty arbitrarily as a way of always having a partner to practise roleplaying assessments in the early days, but I now count them as good friends. An unexpected advantage to remote learning is that we can easily ping messages to each other during training sessions without being seen, and on more than one occasion have we ended up needing to hide giggles behind strategically-held mugs. Thank goodness for the mute button! These are friendships unlike any I think I have experienced before. We have supported each other through bad days, seen inside each other’s homes, worn dressing gowns on camera- and yet the other week we found ourselves sharing our heights and confirming that we did all, in fact, have legs, as we have never met in the flesh. There is both an intimacy and a disconnect in our relationships which can be humorous and tiring in equal measure.

                There are three final (brief, I promise!) points which came to mind when I was thinking about writing this post. The first is my sleep. Although I can take a while to drop off, once I am asleep I have never had a problem staying that way! That is, until starting this job. For the first time in my life I found myself waking multiple times a night, thinking of risk assessments and safety plans, often with an accompanying worry that I might have missed a vital question or bit of admin. This eased after a few months and I now rarely wake like this, but at the time it created an additional layer of tiredness that wasn’t overly welcome!

This leads me to the second reflection. Early on, I noticed a decreased tolerance in myself for the woes of my university friends who have also recently embarked on new careers. This, too, has eased as I have become accustomed to the job, but it is still worth mentioning. Although I would never say it to them (I hope you can credit me with a touch more tact and diplomacy than this, dear reader!), I was sometimes aware of a small swell of frustration when others complained about work-related stresses. The rational and kind parts of my brain are fully aware that stress can exist in any job, especially this year, and I am truly happy to be there for my friends as and when they need to offload. But when someone is worrying about getting a report written on time, I sometimes want to offer a metaphorical slap of perspective by pointing out that there is very little chance of physical or emotional harm, or even death, if they drop the ball for a day. When particularly stressed, I sometimes feel that I do not have that luxury.

I should note, I am wary of sounding at this point that I am overdramatising my role, or that I am ungrateful for it. I feel incredibly fortunate for this job, and as mentioned previously, I am hugely grateful for the support within the service. I am just trying to present the worries and frustrations of an overwhelmed trainee, in those moments.

How it can feel assessing someone with someone with a more complex presentation than you were expecting!

The third and final thread in the tapestry is that of personal growth. One of my main weaknesses, and something that has been picked up on by friends and family more times than I am entirely happy about, is my lack of assertiveness. I am not shy, and like many can present a front of confidence which is not reflective of what is happening under the surface. But I have never been able to deal with even a hint of conflict or disagreement, in any setting. I would put my fingers in my ears if someone returned food at a restaurant as I found it so excruciatingly uncomfortable. I’ve been known to sit for hours with cramp in my foot rather than ask someone to move slightly. I know, I’m aware it’s an issue! But through working with so many different people, colleagues and clients alike, a small pearl of self-assurance has started to grow, almost imperceptibly. I find myself speaking up for what I need, and taking the lead in conversations with clients to steer them where I need them to go in a way that just months ago would have been unthinkable. For all the frustrations, worries, and exhaustion of starting this job, there has been personal development that I had not expected so soon. When I finally go to a café or restaurant again, I reckon I’d even be able to send back my own order if there was something wrong!

There is no neat ending to this reflection. The tone and content of what I want to write about has been changing on a daily basis, which in itself mirrors just how varied life in IAPT is, and I have tried to give a balanced and honest view. I feel enormously privileged and proud to do this job, and although I’m frequently exhausted, knowing that I have been even a small part in someone’s journey towards accessing the support they need spurs me on. Who knows what the future holds – for me, for IAPT, for the NHS – but for now, I will keep doing my imperfect best within an imperfect system. It’s all any of us can do.

I find it incredibly helpful to remember the Starfish story when I feel overwhelmed

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