Debrief

A concern that’s come up multiple times for myself and the other placement student working with me is the lack of training and supervision we have received in terms of handling the emotional aspects of our jobs.

Due to having received no training, my immediate (and unconscious) reaction was to assume that no training is needed. In hindsight this is clearly flawed, but this has been my stance. I figured that I am expected to deal with the emotional aspects of my work silently and competently, by myself, and that as a result it should not impact me.

My colleague is of a different opinion; she thinks that the things we have witnessed, such as awake craniotomy, a cardiac arrest on the ward, people expressing confusion fueled aggression deep in the throes of dementia, and the general states of emotional and physical disarray displayed in ward and clinic settings – she thinks that it’s ridiculous that we have never been formally taught how to process such things. After some consideration, I do too – but I also understand that my emotional wellbeing is not a priority to the hospital, and that if I want to pursue a career in psychology (which I dearly do), then this is something I need to learn to take in my stride.

We received some formal training on debriefing purely by chance – we attended a neuropsych masters training day, in which the psychologist took the students through some debriefing procedures and explained why they’re important. One that particularly stood out to me is as follows; at the end of the day, you take a physical folder, and you visualize putting all of the patients you have seen that day’s files into the folder; you shut the folder, leave it on your desk, and exit work. You do this at the end of your day, and you leave work with all of the thoughts safe in the file, rather than in your head. He stressed the importance of not taking your work home, and explained how he does not think about any of his patients outside of work, and actually forgets who they are unless he is in ‘work mode’.

I currently have mixed feelings about this approach. I can absolutely see the merit in it – leaving my work at work, not thinking work thoughts in my personal life, not dwelling on difficult or challenging patients outside of work time. However, I have also found great value on reflecting on my patients, and as there is no time to reflect on them within work, these reflections happen in my personal life rather than my work life. I have found it useful to go over my interactions with patients; what I could have done better, how I could have presented myself in a better way, how I could have explained something better, how I could have been more empathetic. I have also found it incredibly valuable to reflect on some of the emotions that work throws up – particularly in difficult and distressing cases. Why did a patients psychotic episode make me feel anxious? Why did a dementia patient quite far removed from reality make me feel nervous? Why does brain surgery make me cry? I have found that mulling over such questions allows me to access a deeper understanding of myself in relation to my work, and allows me to be more mindful of similar situations as and when they occur than if I hadn’t given them consideration.

I think that it is possibly because I am still so new to this work that personal reflection is currently so valuable to me – I think that if I had been leaving my work at work all the time, I wouldn’t have developed my understanding as much as I have, and as a result, I would be working at a lower standard. I think that when I am trained and qualified and I have multiple patients under my direct care as day to day work, then leaving my work at work will become valuable and perhaps necessary for me. But as it stands, I am currently deriving more knowledge and understanding from taking my work home and examining it then I would if I were to leave it where I found it. As a student psychologist, I am still extremely grateful to have been given the opportunity to practice psychology without a degree, and it is in my interests to get as much out of this experience as possible. There have been times when work has interfered with my personal life, but this has never bothered me or made me wish it were different; I am doing this because I want to learn, I want to understand, I want to be better.

I feel that this links in with the dichotomy so often observed in care professions; the students are overflowing with motivation, they care so very much about their patients, while the consultants care little – the reason being that they have become jaded, they have seen so many patients that they have learned to detach their emotion from their work, and they do not go further than they need to.

I think that training in debriefing and the cultivation of an ability to leave work at work are both valuable skills to learn, and probably necessary for qualified psychologists to accurately and safely do their jobs. But I also hold on to the idea that reflecting on patients in your personal life is valuable – I have learned a lot from patients, and the things they have taught me are not just confined to work; they permeate all areas of life, and can be integrated into my thinking about life in general, not just life as a psychologist. I think that to go to either extreme; not caring about patients at all while outside of work, caring so much that they impact your personal life; is ill advised, and that (as with everything) the best thing to do is to find a balance between the two.