This week I got to do a Q&A for Occupational Therapy (OT) students heading out on their first clinical placement.
We talked about feedback, stress management, competence, getting along with your supervisor and more.
It struck me, as I reflected on the session, just how polar opposite the experiences of students heading out on placements can be. For some students, work and clinical placements are incredibly rewarding. For others, they are a real psychological challenge.
That got me interested in whether I could explain both responses from a single framework. Fortuitously, I had a meeting later in the week that provided that framework. It is a framework I’ve spoken about before – psychological needs.
What are psychological needs?
We all realise that without food, water, air, shelter and clothing, we would get sick and die. These are our physical needs.
It turns out that humans also have psychological needs. If we don’t get these psychological needs met, we can also get sick.
Psychological needs are subjective experiences/feelings that we need in order to be happy and contented. If our psychological needs aren’t met, we suffer mentally and emotionally and run the risk of developing mental illness. Conversely, if our psychological needs are met, then we feel contented and worthy and connected to the world and others.
There’s debate around how many psychological needs we have, but we only need to consider 3 to get a good sense of why work and clinical placements can have such an effect on us.
We want to feel like we are good at the things we do, and that we have the capacity to improve/grow over time.
We want to feel like we are in control of at least some aspects of our lives, that we can shape the outcome of our lives.
We want to feel like we have a place on this earth, that we belong to a group or groups where they need us and we need them.
How work placements can meet these psychological needs
Work and clinical placements can give us a powerful psychological boost, hence why they are experienced by some students as a very rewarding experience.
Work placements are the ideal setting for us to:
- demonstrate our competence by applying what we’ve learned in our degree
- experience accelerated learning and development that reminds us of our capacity to improve and grow
Not surprisingly, many students leave their placements feeling much better prepared to work in their chosen field and much more competent in their field.
When we have a successful placement, it reinforces our choice of degree/career direction. It makes us feel like a capable and competent guiding force in our own lives.
We also get the experience of being an effective participant in the workforce, and some confidence we can successfully make the transition from university student to worker.
If we have a warm and welcoming supervisor and/or have the experience of being part of a close knit team, we feel valued and needed and have the experience of both contributing to a group, but also the experience of being welcomed and valued by a group. We have an experience of belonging to a work team and discipline area. If our placement is about helping people, we also connect to a broader ideal of being a competent ‘helper’.
How work placements can challenge our psychological needs
Work and clinical placements can also (unfortunately) be a setting in which our psychological needs are not met, and hence be experienced more negatively.
Sometimes we find that our competence as students (doing assignments, exams etc) doesn’t easily translate to being competent at the job. I found writing about psychology quite easy, but much more difficult applying it to working directly with people. We take a hit to our sense of competence because of the differences between studying a profession and working in the profession.
We might also end up at a placement where we don’t feel like we are learning or developing as fast as we’d like. I had a clinical placement where access to clients was limited and as such didn’t get to practice my interviewing skills much. I felt a bit lost at that placement.
You might experience on a placement the feeling that you’ve made the wrong decision in terms of career. Perhaps the work was very different to what you expected. This might lead you to question your choices and doubt your decisions. This can feel quite disorienting.
Your experiences might also have you doubting your ability to make the transition from study to work, and thus closing down your post-study opportunities/choices. This can feel like a sense of hopelessness about the future.
You might end up with a supervisor or in a clinical team where other pressures have meant they aren’t as welcoming as would be ideal. You don’t get the sense of being part of a cohesive team or workplace and end up feeling a bit isolated or alone.
Similarly, for those on clinical placements, you might experience a challenging population of people to help and find yourself questioning your value as a ‘helper’.
Knowing this, how should I mentally approach my work or clinical placement?
If you get a placement that meets all 3 psychological needs, then this is fantastic. I had this experience at one of my placements. It was a critical building block of my subsequent career.
However it is wise to prepare yourself for the possibility that you won’t. In this case, look to see if you can get at least one of these needs met.
- If you don’t like the work, try to connect with the people. Connections/networks I made at my clinical placements were instrumental in shaping my career afterwards.
- If you don’t like the people, focus on getting as good at the job as you can. Dive into the work and learn as much as you can whilst you have the chance.
- If you feel out of your depth, ask the people at the workplace to give you as many practice opportunities as you can get.
- If you are feeling like you’ve made the wrong choice of career, remind yourself that the current placement is just one instantiation of how a career in that area might look. It is not the only example. We tend to generalise a bad experience at placement as indicative of what will become a bad career. This is rarely the case though.
- Be open to feedback, even if it feels uncomfortable, as feedback is one of the best tools for encouraging you to practice, which in turn is the basis of developing competence.
- Show interest in the work being done by your supervisor. Ask questions, and inquire about how they developed their own skillsets. This is a simple way to build a quality relationship with your supervisor.
- Articulate your goals for the placement clearly to your supervisor, so they understand what you are hoping to get from the placement and are better placed to try and create those experiences for you.
- Develop routines and processes for the new skills that you are learning on placement. Routines and processes help us consolidate learning (competence) but also give us a sense of control and predictability over the work (autonomy).
- Remind yourself that challenges to our core psychological needs can ‘feel’ quite distressing and disorienting, but that you can take deliberate action to get at least 1 core need met in just about any placement situation.
- Remember that in situations where some of our psychological needs are not being met, we can look to try and meet them in other ways, outside of the placement
- If you aren’t feeling competent at the placement – increase your subject relevant reading outside of placement
- If you aren’t feeling in control at your placement – add routine and order to your life outside of placement
- If you aren’t feeling connected and like you belong at placement – be deliberate about connecting to friends, family and peers outside of the placement
Work and clinical placements are an essential aspect of university training. They constitute one of the key mechanisms through which students transition from being a student, to being a working professional.
A key reason why psychologists and mental health professionals are asked to speak to students about placements is because placements impact us at the level of core psychological needs.
Knowing this means being able to prepare oneself psychologically for the fact that placements can elicit in us powerful emotional reactions.
With just a few simple shifts in perspective, we can find ways to maximise psychological need satisfaction even in less-than-ideal placement situations.