Dr Julie Scheiner

I have been working with clients with learning disabilities (LD) since 2005, when a chance meeting with a forward-thinking colleague gave me the opportunity. While still a trainee, I found myself immersed in a client group that I had little knowledge of, and to be honest I was probably quite scared. I had no idea what to expect. When I joined my first team, my manager informed me that within a month she was going to retire, and if I wasn’t worried before I was now terrifed! I was literally thrown in at the deep end – sink or swim. My only option was to swim and pretty fast. I am now the lone psychologist on a ward with a team of psychiatrists, OTs, nurses and support workers.

LD work is not sexy! In fact it’s messy, challenging and exceptionally tough work. With this population you may see little change in clients, and at first I often wondered what I was doing working with such a challenging client group. Working with nonverbal clients and/or violent behaviour is particularly difficult, and can be frightening. Autistic clients can also be a challenge, but gaining their trust and helping them through their difficulties is as rewarding as it is tiring. When I do see changes in clients, they feel like miracles.

Since the work is tough, it is vital to be a team player, but our team tends to naturally bond, despite our disagreements about clients. Part of why I specifically wanted to train as a counselling psychologist is that I wanted to be a therapist in the purer sense of the word. Part of my role as I understand it is to gently encourage and educate my team members to remember that a client is not acting up just to annoy them and make their day bad, to recognise that it is part of a client’s presentation, and to formulate with this in mind.

I can safely say that there is simply no day that is similar to any other on the ward. I usually arrive at work earlier than my allotted 9am start. I like to get to work early as I tend to help out with breakfast. I know that this is not part of my job description, but it enables me to see my clients outside of my formal role. One thing I have learnt is that my clients, especially those in community settings, have very little understanding of why they’re being brought to see a psychologist. They don’t necessarily open up and share their inner world – they don’t have the verbal skills, simply don’t want to, or don’t understand their own behaviours. By my serving breakfast, clients see me as part of the team. I have the respect of the nursing team and support staff. I never want to be seen as ‘The Psychologist’ – cold and unapproachable.

What I have realised working with clients with LD is that as a psychologist you’ve got to be creative and flexible. Working on a ward, I don’t see clients at specific times, as this does not always work for them. I have an open door with clients and often work at their level wherever they may be comfortable. I encourage my clients to dictate the place, time and length of sessions, allowing them to work at their pace. The majority of my work is collaborative, creative and for the most part carried out with other health professionals – we all work together in support of our clients.

Nothing in my training prepared me for how challenging and how rewarding this client group can be. In fact I am continually learning about my clients, and they come with a variety of presentations and diagnoses that continually make me think about how best to work with them. However, the one thing that my counselling psychology training has prepared me for is ‘being with’ my clients, walking alongside them on a journey of discovery, being able to understand their inner world as much as possible. This is not just about my LD clients but all the clients I see.

This piece is not a full picture of my job as an LD psychologist because there is so much more that I could write about, but I hope it gives readers a flavour of what it is to be an LD psychologist. I think what makes me unique is that I am happy to get involved, and when a psychologist is happy to do that and perhaps go the extra mile, it makes you stand out from the crowd. Having passion and enthusiasm is great, but being part of a team – and I mean really part of a team – makes my job so rewarding. I see subtle changes in my clients every day, leading ultimately to big changes, and to know that I’ve been a part of that process makes me extremely proud of my clients, my team and myself.

This piece has been inspired by my supervisor, Alan Frankland, whose continued support, warmth and compassion have made me the psychologist I am today.