Education and training of future psychologists with Dr Elly Quinlan

This episode explores the education and training of future psychologists with Dr Elly Quinlan. Elly describes her research unpacking tolerance of uncertainty in psychologists working with complex clients or clients who might be at risk, as well as the potential for discomfort to lead psychologists to avoid asking clients about their sexual abuse histories.

Dr. Jasmine B. MacDonald (00:08):
Hello, and welcome to another episode of psych attack. I'm Dr. Jasmine B MacDonald. Today, Dr. Elly Quinlan, and I explore the education and training of future psychologists. I hope you're going well and have settled in with a warm cup of tea. Elly, thanks so much for coming along to have a chat with me today.

Dr. Elly Quinlan (00:33):
No problem. Thanks for having me.

Dr. Jasmine B. MacDonald (00:36):
So I was thinking maybe a really nice place to start would be for you to, um, tell us a bit about yourself, um, and your background.

Dr. Elly Quinlan (00:46):
Sure. So I did my initial university training in psychology and pursued the professional psychology pathway. So I became registered as a psychologist under the five plus one and worked, um, clinically full time for a few years, mainly doing therapy and assessment with teenagers, children, and families, and then went back to university to, um, do a PhD alongside part-time work and then moved into, um, academia.

Dr. Jasmine B. MacDonald (01:24):
So what motivated you to come back into a PhD?

Dr. Elly Quinlan (01:29):
Um, I think opportunities to research when you finish your formal studies, um, and your working in the field can be, um, hard to find and was really interested to learn a bit more, both about the process of researc- research, but also have the opportunity to, um, produce something.

Dr. Jasmine B. MacDonald (01:50):
Yeah. Nice. Why psychology? What brought you to psych in the first place?

Dr. Elly Quinlan (01:57):
Um, I think I stumbled upon it in a way, uh, started off doing sociology, um, as I was interested in people, but found it, it didn't feel like the quite right fit for me. And I went and had a chat with the career advisor at the university and, um, she suggested try psychology. So I, um, went along to a lecture just to test it out and found it really interesting and it felt like, um, it felt like a challenge for me. Um, and yeah, just went with it from there.

Dr. Jasmine B. MacDonald (02:39):
I actually I'm grinning as you say that because, um, through my own studies and through teaching as well, that, um, switching people tend to do between social work, psychology and sociology is pretty common.

Dr. Elly Quinlan (02:52):
Mm.

Dr. Jasmine B. MacDonald (02:53):
And I actually had a similar experience of studying social work, um, sociology and psych and finding psych really challenging and then being attracted to it. maybe indicative of a personality trait there.

Dr. Elly Quinlan (03:06):
Yeah. Yeah.

Dr. Jasmine B. MacDonald (03:09):
Um, so, um, your, your area of interest and expertise is education and training of, um, future and, and practicing psychologists.

Dr. Elly Quinlan (03:22):
Yeah. So I'm really interested in kind of two areas, the, as you said, the training and education of, um, aspiring psychologists, but also what impacts on the process of therapy. So a lot of research in applied psychology or mental health training, um, is very clinically focused where you look at different groups of disorders like depression, um, social anxiety, researching schizophrenia, or looking at types of intervention, like cognitive behavior therapy or schema therapy. Uh, but I found that more and more, I'm interested in the kind of common factors or the invisible processes that happen in therapy across all of that and then understanding that more gives an opportunity to incorporate that into the training that we provide, um, to be able to put in some of this stuff, which is there, but not spoken about.

Dr. Jasmine B. MacDonald (04:32):
Yeah, absolutely. What do you tend to draw on in this topic, um, in terms of your understanding of psych kind of theory and practice?

Dr. Elly Quinlan (04:42):
For me, it's really looking at the process of therapy. So we, we know a lot about things like the therapeutic Alliance, the connection between a psychologist and their client, um, and a lot of training focuses on that, and then as I mentioned before, it often then jumps from, you know, the connection's really important and how you interact and sit with a client is important. Um, and now let's look at groups of interventions or groups of disorders, and there's so much more richness to what happens in the room between, um, psychologists and their clients.

Dr. Jasmine B. MacDonald (05:25):
Yeah. Yeah. And shifting away from, um, that focus of, um, maybe even specifically a focus on the, the, uh, foundational theories of psychology and more of the meta aspects of, you know, what, what the person brings and what that experiences like for them.

Dr. Elly Quinlan (05:43):
Yeah. Yep. Definitely.

Dr. Jasmine B. MacDonald (05:45):
Um, I'm kind of interested when I talk to researchers about their work. When you sit down and you talk to people or you are like pitching ideas or talking about your research, are there any assumptions that people bring to the area? So you say, I, I research, um, um, education and training of, um, professional psychologists or future psychologists. Um, are there any assumptions that people jump to and they think, oh, so you must do this and you're like, no, that's not quite actually what I'm interested in.

Dr. Elly Quinlan (06:13):
Yeah. I think as I mentioned, um, probably the main one is looking at groups of, um, disorders because that is how, you know, that framework, that medical model kind of diagnostic framework is, um, really underpins a lot of current clinical training. So often when i give, um, talks about my research interests or I'll make it really clear that I'm, I'm interested in, you know, process process of therapy and kind of common factors. Um, but I still get a lot of students coming to me saying, oh, I really wanna research, um, you know, schizophrenia or borderline personality disorder. Um, and that's not quite what I do.

Dr. Jasmine B. MacDonald (07:05):
And you smile and you're supportive, but you're kind of dying a little bit inside.

Dr. Elly Quinlan (07:10):
mm-hmm yeah.

Dr. Jasmine B. MacDonald (07:13):
Not quite that's dramatic, but yeah, I see what you're saying. Yeah. Okay. So set the scene for us. You, you become really interested in this topic, what was kind of being done in this area before you started and what did you see is the, the problem that you wanted to address?

Dr. Elly Quinlan (07:30):
Yeah, so, um, I was lucky that I've had some really great mentorship through my career and it was actually my PhD supervisor, Frank Dean, um, post PhD we were talking about, you know, this general area and potential research directions and he said, um, you know, I'm gonna give you a gift Elly of an idea that I don't have time to pursue. Um, I, I think you should look into uncertainty in psychologists and so that, that was really the start, um, looking into this idea of uncertainty, which is a word that I had heard used a lot, theoretically when training students all talking about the work we do, but not in a research context. So we, um, I had a, had a bit of a scope on that and there's really extensive literature around uncertainty in the medical field, particularly in training of doctors, uh, by un uncertainty, I'm referring to that quality of being unsure or, um, not, not having direction or feeling like you have enough information and it tends to happen when a situation is ambiguous or really complex, or there's an element of risk involved. So there's a lot of literature around uncertainty in doctors, which shows that when doctors are not quite sure about what a patient is presenting with or the best way to, um, assist or treat a person, they have a lot more anxiety, they're more likely to feel stressed and burnt out, and they're also less likely to collaborate and make shared decisions with their patients and they kind of fall into an expert mode.

Dr. Jasmine B. MacDonald (09:40):
Mm, interesting.

Dr. Elly Quinlan (09:41):
And the other interesting thing is that uncertainty is both a state that can come about depending on the situation, but it's also a personality variable. So some people are more prone to experiencing uncertainty than other people and people vary in their capacity to hold that uncertainty when it comes up. Some people, it feels comfortable and, and natural and okay, and other people, uncertainty feels extremely threatening, even when it's a situation that doesn't have an identifiable negative outcome, it still feels really uncomfortable for some people.

Dr. Jasmine B. MacDonald (10:27):
That's super interesting. So is this like, why is that, is it about making some kind of attribution or assumption of the, there will be a negative outcome, even if the, it seems like a neutral situation?

Dr. Elly Quinlan (10:42):
Yeah. It could be. There's a few different models about uncertainty in, in this kind of allied health context and one of the things which does contribute is how people appraise or make sense of uncertainty and people can look at it and think this is an opportunity to learn more and understand, or they can view it and think this is a threat.

Dr. Jasmine B. MacDonald (11:08):
Okay. So, um, we have this background, literature and doctors, um, what makes you interested in uncertainty in psychologists?

Dr. Elly Quinlan (11:18):
So, as I mentioned before, it, it felt like something which was really intuitive for me in that of course, uncertainty would play out in the work that psychologists do, but there hadn't been any research on it. Um, and reflecting on the work in psychology in comparison to fields, such as medicine, um, although medicine also has a lot of uncertainty and there can be overlap between conditions there is that biological or physical element where, you know, if you perform the right test or, um, investigate in a certain way, you, you can find biological evidence to say, okay, this is what's happening for the person, but we don't have that in psychology.

Dr. Jasmine B. MacDonald (12:09):
Right.

Dr. Elly Quinlan (12:10):
There are no, well, research seems to be indicating that there are no, um, biological markers for a number of conditions where you can look at someone's brain and say, yes, they have, you know, depression, or they have anxiety. There's a big element of subjectivity to it and for, I think that context would bring out a lot of uncertainty because we don't have often anything physical to fall back on.

Dr. Jasmine B. MacDonald (12:42):
Yeah, for sure.

Dr. Elly Quinlan (12:43):
There's a lot of overlap too. Um, I mean, there's a lot of problems with our current diagnostic system. Uh, but one of one, one that's relevant to this topic is that there is a lot of overlap between symptoms and disorders. So people often don't neatly fit into a diagnostic category or they might fit into multiple categories and then if you've got someone with, you know, four potential diagnosis, what, you know, where do you go with your treatment? Um, so that can create a lot of, of uncertainty and there's also a lot of, um, a lot of risk in the role too, because we need to weigh up, you know, are the people that we are seeing safe, both safe within themself, safe for other people, um, you know, are they likely to harm people in their life? Are there a danger to the public? And again, you know, you don't have anything really tangible to fall back on there. You need to make that judgment clinically based on a lot of subjective information and based on the information your client gives you, which, you know, they have their own agenda too

Dr. Jasmine B. MacDonald (13:56):
Mm-hmm and depending on your role and the context that you work in, potentially in a, um, you know, a short period of time, and you might not see them for, you know, like however long in between sessions or, um, appointments or, you know, what, whatever the context is.

Dr. Elly Quinlan (14:13):
Yeah.

Dr. Jasmine B. MacDonald (14:14):
Okay. So we've got, we have a really interesting research problem. That actually is a really interesting practical problem.

Dr. Elly Quinlan (14:23):
Mm.

Dr. Jasmine B. MacDonald (14:23):
How do you go about addressing that, addressing that? What, what did you do?

Dr. Elly Quinlan (14:27):
So the first thing that I've done in this area is I wanted to just understand it from a really open perspective, because again, nothing had been done in a research context. So my initial work in the area has been qualitative by going out and speaking to psychologists to understand what is bringing up uncertainty for you. Is it happening at all? If it is, how is it impacting you? Um, what, what do you do when it shows up? How do you, how do you hold that or manage that? And has it changed over time? Has it always been in there? Does it come and go? Um, so going, going to the people who are impacted by this to understand, and try and generate a bit of an understanding or a model, because I didn't want to assume that the work that has been done in medicine would necessarily translate over. So I did a project, uh, I think last year, um, or maybe 20 maybe before the years, or have rolled into one after COVID.

Dr. Jasmine B. MacDonald (15:46):
Absolutely.

Dr. Elly Quinlan (15:49):
Yeah. Where, uh, I spoke with, with 24 different psychologists to understand, you know, were they infl-, were they, um, experiencing uncertainty and how it came up? And some of the things that they were the first thing actually, before I even get into what I found was I was really surprised by the interest in the project. I had a lot of participants come forward and say, you know, I'm really excited to talk about this because I haven't had an opportunity to talk about my uncertainty before, or,

Dr. Jasmine B. MacDonald (16:26):
Um, that's when, you know, you're under something interesting. Right. It's not just you.

Dr. Elly Quinlan (16:29):
Yeah.

Dr. Jasmine B. MacDonald (16:30):
, you're like, okay, cool. It's a little bit of confirmation, this is worthwhile.

Dr. Elly Quinlan (16:35):
Yeah, definitely because, you know, finding, um, finding participants in research can often be a bit of a struggle. Um, so it was really nice to have people, people coming forward and saying, you know, I'm, I'm really keen to talk about this.

Dr. Jasmine B. MacDonald (16:50):
So, um, just for maybe some, um, listeners who may not have a psych background in terms of participants, we're talking about registered psychologists who attending to do therapy.

Dr. Elly Quinlan (17:03):
Yep. Yep. So to be eligible, to be in the study, they had to be registered as a psych. So they had to have completed their training. I didn't have any limitations on how long they had to be practicing for. Uh, but they did need to be currently working with clients, um, in a applied role.

Dr. Jasmine B. MacDonald (17:25):
Yeah. I just point that out. Um, thinking about, um, sometimes people not being aware that people can train or like have a PhD in psychology or have an undergraduate degree in psychology, but not actually be able to call themselves a psychologist. So, um, what we're talking about here is practicing psychologists.

Dr. Elly Quinlan (17:42):
Yep. Yeah. So some of the, some of the things I learned from these participants were first that uncertainty was really common in the sample. Um, every, every participant spoke about, um, having experiences of uncertainty. There were particular elements of the work, which brought about uncertainty, which I can, I'll tell you a bit more about, but there was also this sense of it's just in it's part of the field. It's part of what we do. Um, people struggled to put words to it, but it was like, you know, it's this thread that's always there.

Dr. Jasmine B. MacDonald (18:24):
Isn't that interesting that they're acknowledging, it's always there it's, it's, it sounds like it's more of a feeling than something that's ever articulated like people aren't really talking about it, but they're so motivated to talk to you about it. And it's, it sounds like it's so widespread. I think that's fascinating.

Dr. Elly Quinlan (18:41):
Yeah. And there were certain elements of the work, which brought it up more often. So particularly if participants were working with complex clients where they weren't quite sure what might be going on for them diagnostically, um, any clients who were risky and then also working with multiple clients where you might have, you're supporting a child and a parent and they might have conflicting interests or their stories don't match up.

Dr. Jasmine B. MacDonald (19:14):
Mm.

New Speaker (19:16):
Uh, participants also talked about when the direction is unclear. So when there's not a clear therapeutic path to take that brought up a lot of uncertainty and ethical dilemmas. So anything that fell into that gray of, you know, I'm not quite sure if this person is at risk or not, or I'm not quite sure if I need to report this in terms of child protection or not. Um, that brought up a lot of uncertainty too, and participants described, when it showed up, it had, it had a large, um, impact on them in the room in terms of people tended to go either one of two ways, they tended to have a bit of an anxious response and have, you know, the butterflies in the stomach, heart beating faster, fidgeting, feeling a bit overwhelmed, or, or they tended to become frustrated.

Dr. Jasmine B. MacDonald (20:15):
Mm.

Dr. Elly Quinlan (20:15):
And they would feel really tense and almost angry,

Dr. Jasmine B. MacDonald (20:21):
Angry, how so?

Dr. Elly Quinlan (20:22):
aThat sense of, I wanna know what to do and I'm frustrated that I don't understand at themselves.

Dr. Jasmine B. MacDonald (20:29):
Yeah, yeah, yeah. This whole norm of the psychologist, as a person who's gonna have a reaction to a situation is really interesting. .

Dr. Elly Quinlan (20:38):
Mm.

Dr. Jasmine B. MacDonald (20:40):
And maybe we don't do it enough. .

Dr. Elly Quinlan (20:43):
Yeah.

Dr. Jasmine B. MacDonald (20:44):
Um, okay. So, um, did they talk to you about how they manage those situations? Because that sounds really uncomfortable. Um, either feeling really anxious or frustrated, um, what do we do in that situation?

Dr. Elly Quinlan (20:58):
Yeah, so there was a lot of, um, a lot of self-doubt came up for people, so they would question their own compentency, question, you know, am I doing the right thing? Am I, you know, a decent psychologist at all? Um, it brought up a lot of that imposter syndrome, but in terms of practical steps, the main one was seeking supervision from, um, a more senior psychologist, and often they described going to supervision wanting either a really clear answer of tell me what to do. I'm stuck. Um, I don't know the path or just wanting support and validation that this is really tricky. And the other thing that tended to happen was they would focus on the client. So they would, you know, try and in a way, um, it sounded a bit like overcompensating, so they would suddenly go and do a whole lot of research to, you know, maybe I miss something and I wanna understand more. I'm gonna read the whole file over again and check my notes to see if I've missed anything.

Dr. Jasmine B. MacDonald (22:15):
Okay. So it's not,

Dr. Elly Quinlan (22:16):
or, um,

New Speaker (22:17):
not quite accepting that maybe this is just a situation where I have to sit with uncertainty for a bit. I must have missed something. And so putting in some extra work.

Dr. Elly Quinlan (22:28):
yeah. Yep. And just under half of the sample, uh, stated that they would communicate it to the client. So they would go to the client and say, you know, I'm actually not, not too sure at the moment on what's going on for you or the best path forward, can we work it out together? Um, and that was really in where other participants, um, weren't comfortable having those conversations or felt a pressure to kind of figure it out or fix it before they, uh, had any discussion with the client.

Dr. Jasmine B. MacDonald (23:03):
This Is making me wonder when, you know, earlier on you were saying, there is potentially personality aspect, and if that's the case, then this is there's gonna be this personality aspect of tolerance of uncertainty, not only for the psychologist, but for the client as well.

Dr. Elly Quinlan (23:22):
Mm.

Dr. Jasmine B. MacDonald (23:22):
So if we now have a psychologist come to a client and say, you know what, I'm actually not sure of what the next step is, what , I'm just wondering about that interaction of, if we have this grid of high, low tolerance of uncertainty with the psych and with the client, how this plays out when both have a low tolerance to uncertainty, both in this situation of not being sure what to do next.

Dr. Elly Quinlan (23:49):
Yeah, definitely. And, and I, I think there's been research on that in the medical field where they look at the, um, the client's tolerance of uncertainty and how that then impacts on the interaction, which is really fascinating bit. Um, yeah. Great, great to see how that plays out in, in psychology too. Um, the, the other thing which participants mentioned, which was really interesting because I think it showed just the extent of the impact of uncertainty is it brought out a lot of avoidance. So participants spoke about, they would try and avoid sessions with a client. So they might space them out a bit further than they might. Um, other clients that they're working with, or if the client canceled a session, they felt a lot of relief and in some cases participants talked about, I actually moved them onto a different clinician because I wasn't comfortable working with them and sitting with that uncertainty.

Dr. Jasmine B. MacDonald (24:55):
Mm it's, um, that, um, practical implication is really important to consider because if this work can, can unpack how you can further support psychologists to work through this and that means that they're not avoiding sessions with someone who, like you were saying before, the people that are most or the clients that are most likely to lead to feelings of uncertainty are complex, risky clients. We don't want those people not being in so sessions, you know, referring on makes a lot of sense if you, if you're not feeling like you can work with somebody.

Dr. Elly Quinlan (25:33):
Yeah, definitely. And the last thing that came out of those discussions with psychologists is this idea that for the majority of people, they found that uncertainty was more present early in their career and over time it either was less frequent. So uncertainty came up less, or when it came up, they felt that they could hold it better. But for a, um, minority of participants, they spoke about uncertainty actually got harder over time. So they either noticed more experiences of uncertainty or when it showed up, they found it harder to tolerate, uh, often due to that idea that the more, you know, the more you realize you don't know, um, and, uh, you know, that brought up really interesting questions for me about, you know, what, what makes that difference for people who find this easier with time and experience and people who find it, it just gets more prevalent.

Dr. Jasmine B. MacDonald (26:48):
mm-hmm . Is that something you've, um, started to be able to work out yet? Or is that maybe something you'll, you'll explore in the future?

Dr. Elly Quinlan (26:55):
Some initial steps. So I've been working on a longitudinal project to try and understand this idea of uncertainty changing over time, where I've looked at psychologists at the commencement of their postgraduate training. So the start, the start of their, my master's degree, which is often where people will start working with clients for the first time and trying out their therapy skills. So I've done a project where we measured uncertainty in two ways; uncertainty in daily life, so trying to tap into uncertainty as a more personality distribution, how do I feel about uncertainty in general, and then uncertainty specific to client care? So the uncertainty in the work that I do, and we gave them a vignette of a client who was deliberately ambiguous, where it wasn't quite clear what was going on and asked them to give us an explanation of what was going on for the client, and then immediately after that, measured how anxious they felt, um, in that we weren't actually interested in explanations of the client. Um, we were interested in how anxious they felt when they tried to manage, um, an uncertain clinical situation. So we, we followed that same process at the start of their training and the initial few weeks, um, eight months later, and then at the one year point to look at, does this change over time? And what we found was uncertainty in regards to kind of daily life didn't change. So if people came in with a low tolerance for uncertainty in life, in general, they tended to still have a low tolerance for uncertainty a year into their degree and vice versa. But generally the uncertainty in regards to the work with clients, um, changed and improved. And the more that it changed over the year. So the more specifically, the more that it improved, the less anxiety they had when we gave them the ambiguous cases.

Dr. Jasmine B. MacDonald (29:37):
Mm, interesting.

Dr. Elly Quinlan (29:38):
Uh, which shows that its not necessarily that these are just anxious clinicians who struggle with uncertainty in general, and therefore it's coming up in their study. It didn't matter if they had high or low tolerance of uncertainty as a person or in their life. What made a difference was how much uncertainty they had in the work that they do with clients.

Dr. Jasmine B. MacDonald (30:06):
Mm. Yeah. That makes a lot of sense. Right. They're mastering a skill or, you know, developing this skill, um, which it, again, sounds like it's coming back to a bit of a difference between maybe a bit of a, um, trait.

New Speaker (30:21):
mm.

New Speaker (30:21):
Tolerance to uncertainty compared to a state, um, that might,

Dr. Elly Quinlan (30:26):
mm.

Dr. Jasmine B. MacDonald (30:26):
Maybe it's a bit longer than state because it's over an extended period of time training, um, the not extended period of time, but, um, it's not just gonna pass over a matter of hours or, or a couple of days or something.

Dr. Elly Quinlan (30:38):
Mm.

Dr. Jasmine B. MacDonald (30:39):
But through knowledge and experience, develop and improve.

Dr. Elly Quinlan (30:43):
Yeah. Which, which is really promising from that training angle, because it doesn't necessarily matter if people come in to their degree with a lower tolerance of uncertainty as a person, because we know that if we train them to be able to increase that capacity, to hold uncertainty and the, um, applied work that they do, that that can change. Um, and that for me is really exciting and where I wanna take this research in the future, looking at what elements of training can help aspiring psychologists, understand uncertainty and accept it as an inherent part of the work that we do, that it's not always about finding the right answer or finding a clear, um, a clear path. There might not be one. And there are times when we need to sit with that and be transparent with the people we work with of the limits of our knowledge.

Dr. Jasmine B. MacDonald (31:46):
Yeah, absolutely. So, um, I, I'm hearing you say, you know, that that's something you wanna explore next. Like, what is it that you can add to training to develop that understanding and that ability to sit and, um, uh, tolerate ambiguity, that uncertainty, what, what's your kind of sense as someone with professional experience and having done research in this area, what do you think are things that, um, maybe do make this easier or might be useful?

Dr. Elly Quinlan (32:19):
Yeah, it's a big question. Um,

Dr. Jasmine B. MacDonald (32:22):
That's what, that's what we do here.

Dr. Elly Quinlan (32:25):
Yeah. And I'm really not, not sure because it hasn't been empirically tested, but I would suspect that normalising would play a massive part. So even giving trainees education about, you know, there will be times in the work that you do where there's not going to immediately be a clear answer and that's okay in those times, rather than viewing that as threat and perhaps getting on the defensive and withholding information from the client and kind of scrambling to, um, find an answer, you know, what are some adaptive ways we can approach that, which might include talking to a supervisor about those concerns or fears or seeking advice on, you know, maybe there are some steps that can be taken in the interim.

Dr. Jasmine B. MacDonald (33:25):
Mm. I, I think that's really interesting Elly because, um, as you just mentioned, it's not until that postgrad study often until people start to have experiences, at least if they've come in and done the psych psychology part pathway all the way through before, they're actually working with people. Mm. So they might not realize until that point until they've done maybe three years of undergrad, a fourth year doing, you know, honours research and then gone into a master's program, potentially a bit of space in between if they've, you know, um, you know, done whatever else in between getting an to a master's program before they realize this thing that they've been training to do that they've been really excited about and they wanna call themselves a psychologist is actually really hard and there's not, there's not a clear answer and the way that we train in undergrad is, is not like that. You know, there, there is ambiguity and there's interpretation and there, there are these things, but it is, there are far more certainties than sitting down face to face with someone. Um, so I think that's pretty interesting.

Dr. Elly Quinlan (34:33):
Yeah. And as you said, our, um, we train people for certainty, not, not for, um, for uncertainty. And there is this idea that, you know, there is an answer. If you look hard enough, or there is a relevant concept, but people are really unpredictable and you know, it's not until people get into postgrad and they sit down with a client and try and follow, you know, this is what the manual says I do in a first session or second session, but the client didn't answer the question or the client got upset and walked out or the client didn't connect with me. What do I do now? Um,

Dr. Jasmine B. MacDonald (35:10):
Hang On, this isn't, this isn't how it's supposed to work. Let's do this again.

Dr. Elly Quinlan (35:14):
yeah. Even having, um, things like, you know, and, and of course it would need to be appropriate to the stage of development because people need to learn the basics first, and we don't wanna overwhelm anyone, but having case studies where maybe there are multiple possibilities or not a clear answer, or a lot of what if questions to help students start to think, okay, when it's not clear cut depression or clear cut anxiety, what do I do with this? How do I make sense of it?

Dr. Jasmine B. MacDonald (35:51):
Yeah, for sure. So I'm wondering then Elly, um, we've covered, um, some really interesting topics of, you know, tolerance of uncertainty, um, in the qual study that you've described, but also, um, looking that longitudinal study of how that might change over the course of training. What other studies, um, or topics are you interested in when it comes to education and, um, of future psychs?

Dr. Elly Quinlan (36:20):
Yeah. Um, another very relevant concept would be discomfort. So looking at clinicians' discomfort with different topics and how that might impact on therapy. I had a, a really great master's research student last year, Belinda Nixon, who had a really great idea to look into psychologist, comfort and discomfort with asking clients about a sexual abuse history after noticing, you know, after some of her own reflection on noticing that she found those questions hard to ask with clients and wanted to know if that came up for other people. And that has been really interesting as you know, the prevalence of sexual abuse and of sexual assault in Australia is extremely high. Um, I think up to one in one in four or one in five women have had these experiences yet it's not routine or often not routine as part of therapy to specifically ask, have you ever had sexual abuse or, um, been sexually assaulted in your lifetime, often will ask about trauma, have you had a trauma or anything difficult happen to you? So we'll ask in a kind of vague roundabout way. Um, but there's a lot of research indicating that more direct you are with the question, the more likely people are to give you that information. Um, you know, for a lot of reasons, because of the shame, the stigma. So we did a bit of work talking with psychologists about do you ask your clients about if they've had a history of, um, sexual abuse or sexual assault. Um, if you do, you know, how, how do you do that and why, if you don't do it, what gets in the way? And we found, we interviewed 12 early career psychologists, and we found that it wasn't routine practice with psychologists saying, you know, that's just an uncomfortable topic, I wouldn't think to ask it. And a lot of that similar avoidance came up up. Then I talked about earlier where people would speak about, you know, if I did have, you know, a, a form as part of my standard intake that needed me to inquire about trauma or sexual abuse and sexual assault, I would rush through it because I felt so uncomfortable asking those questions or, um, putting that out there in the room and a lot of bodily, a lot of bodily discomfort.

Dr. Elly Quinlan (39:22):
And again, you know, you mentioned earlier, you know, considering that human side to the therapist and you know, it, it's interesting that someone can be sitting there in the room, feeling that uncomfortable and that impacted and needing to maintain that professional facade for the sake of the client. So that's another area where it seemed participants talked about, you know, during my training, this was really unspoken. People talked a lot about, you know, the commonality of suicide and the importance of talking to clients about if they've had any thoughts about self harm, but no one openly and transparently talked to me during my training about sexual abuse and sexual assault. And if, if I ask a client about that, what do I do if they say, yes, you know, I'm gonna open up a can of worms and I'm not gonna know what to do with it.

Dr. Elly Quinlan (40:25):
So that was another example of one of those almost invisible things that we need to bring into more conscious awareness of our training and talk to trainees about, you know, as part of your work, you need to have really difficult conversations sometimes. And one of the difficult conversations you might have to have is asking people if they've had any sexual abuse or sexual assault and, you know, how are we gonna, how we gonna get you more comfortable with that idea, you know, validating, modeling role playing, practicing to take away that discomfort. So when they go into that situation, it doesn't feel so uncertain and so foreign

Dr. Jasmine B. MacDonald (41:10):
Mm-hmm . And when we, when we think about, um, in trauma exposure or experiences, that's, that's such a broad spectrum of things, you know, from motor vehicle accidents to, you know, we don't need to sit here and rattle them off, but, um, I think any kind of sexual experience in general comes with a bunch of values and beliefs and taboos and cultural aspects. And then you add the aspect of abuse to it. Um, there's a whole bunch of assumptions and personal reactions to that. So we can't, you, you can't know what it's like to sit with somebody and have a conversation like that until it happens. So to not have it addressed and normalized, and all those things you talked about previously of how do you normalize and, um, and essentially have practice runs and have open conversations about this stuff. Um,

Dr. Elly Quinlan (42:12):
The, the consequences of not having those conversations can be quite dire because if we're formulating an understanding of why someone is in distress, why someone is depressed or anxious based on incorrect or missing information and we form a treatment plan on that when perhaps it was tied to a previous sexual abuse and sexual assault, um, or sexual assault, we're not, we're not going to be doing effective work. And there was one study, which, um, I was a bit shocked by that show that the likelihood that a client will complete suicide is better predicted by previous sexual abuse then by a diagnosis of depression.

Dr. Jasmine B. MacDonald (43:00):
Wow.

Dr. Elly Quinlan (43:02):
So you, you can see that it, it can even have lethal consequences.

Dr. Jasmine B. MacDonald (43:06):
Mm.

Dr. Elly Quinlan (43:07):
If we're trying to keep someone safe and address their risk, and there is a massive elephant in the room, and we're not aware of it.

Dr. Jasmine B. MacDonald (43:14):
We want people to be able to disclose those experiences in, um, with a psychologist if anywhere, but we also want psychologists to feel like they know what to do in those situations and to not be stressed and burnt out or leave the industry because they don't know what, what to do or to feel you know that imposter syndrome or all those things you were talking about earlier. When you were selecting, you know, or thinking about the approach you were gonna take to these topics or this broader topic, why, why qual what, what was the strength of taking this approach to the topic?

Dr. Elly Quinlan (43:50):
Mm, um, I think it came from reflecting on what is it that I actually want to understand or get out of the project. Uh, and a lot of my questions were focused on, you know, understanding what is this, like, what is the experience of this, which lends itself to a more qualitative methodology as if you put in, you know, anything like surveys, they come with a set of assumptions on, you know, what questions are important to include, et cetera, uh, where with, you know, other work like the longitudinal, it wasn't so much about an open understanding, but about finding an answer to a more specific question of does, does this change over time?

Dr. Jasmine B. MacDonald (44:44):
What were some of the potential challenges that came with taking a qualitative approach here?

Dr. Elly Quinlan (44:50):
I think, with any qualitative work, you need to be quite reflective and careful in the design of the study by considering, you know, what are my research questions? What do, what do I wanna understand and find out about, but then also start stepping back and considering what assumptions I am bringing in here, or what bias might I be bringing in, in the way I'm putting these questions forward. And you need to make sure that you're not setting up your questions in a way that they're more likely to get you a particular answer.

Dr. Jasmine B. MacDonald (45:26):
mm.

Dr. Elly Quinlan (45:26):
Or get you information in a certain direction that, you know, you've got a hunch about, or, um, that you are assuming might be important. So I think that that's one challenge I found in qualitative research. I found, I need to just really slow down when designing a project to make sure that I've given enough time to sit with it and reflect on it and even crosscheck often with another person, you know, these are my questions. Do they feel open when you read these? Are there any, you know, assumptions in there that I'm missing? I think with qualitative work, you need to be really mindful of the language you use with the interviews for the qualitative project on uncertainty. Um, I found that I used the word, how do you cope with uncertainty during my interviews? And then later reflected on all the assumptions that go, go along with that, because it's implying that uncertainty is something that needs to be coped with. Um, and I've taken that learning into future research in this area, um, to use a bit more neutral language, even when we try and control for our own some and keep things really open. It, it slips in.

Dr. Jasmine B. MacDonald (46:57):
Yeah. And I guess in some ways you, you might have that reinforced a little bit with some of the things participants are saying to you, but it is really interesting that you sit back and reflect on that and say, hey, you know, it's not, it might not be that everyone's trying to cope with it. As you said, some people actually were seeing it as a challenge and, um, you know, really open about it. You know, you talked about what brought you to this topic and psychology, what keeps you in this topic?

Dr. Elly Quinlan (47:24):
Ah, there's always more to do. first of all, always more gaps. And then also, I, I mean, I'm, I feel really passionate about it. And I feel like the, the, when I get to the later stages of this research, particularly when looking at, you know, what can be brought into training in a practical sense to help people with these problems, um, that to me feels really meaningful because it not only will hopefully benefit future psychologists, but would then in turn benefit all the clients that they support in the work that they do.

Dr. Jasmine B. MacDonald (48:03):
Yeah, absolutely. While I've been listening to you and reflecting on that kind of, um, to, and some uncertainty and some of that discomfort that comes along with professional psych, I think more and more, this is a relevant topic for academics and psychology as well. where there's shifts in, in what we do and, and uncertainty there.

Dr. Elly Quinlan (48:24):
Yeah. I think once you have the, um, uncertainty glasses on the, there's so many, so many areas of life where it creeps up.

Dr. Jasmine B. MacDonald (48:33):
Yeah, for sure. Um, lovely. I, I thought maybe a nice way to wrap up our conversation would be for you to like, maybe just tell us when you're not doing this really interesting research and thinking about, you know, how it might, um, be useful for psychologists and, and for people accessing psychological services, what do you do?

Dr. Elly Quinlan (48:59):
Hmm. Um, I, I like to garden, I like to be outside, um, get my hands dirty. It can be really nice to do something more manual where you don't have to use your brain in the same way. So that, that for me is kind of gardening, weeding. I found it really grounding. Uh, I like to, I like to sew as well, make things and playing board games, but that one has crept into my research life as well. Um, 'cause ended up doing a project on Dungeons and dragons and mental health, but it's also also separate too.

Dr. Jasmine B. MacDonald (49:47):
That is amazing. Um, and I feel like I wanna know, uh, more about that, but it, it sounds like it could be a whole other episode .

Dr. Elly Quinlan (49:57):
Mm. Yeah.

Dr. Jasmine B. MacDonald (49:59):
That's fantastic. Um, maybe we can have some information about that for listeners, if they're interested in the, the notes for the episode.

Dr. Elly Quinlan (50:06):
Yeah. Great.

Dr. Jasmine B. MacDonald (50:09):
Elly let's do that thing, sometimes people aren't that great at doing, unless they're encouraged to some shameless self-promotion, um, you're doing really fascinating work. Listeners are keen to follow up on what you're doing or keep in touch with, um, what, what you're up to, how can they do that?

Dr. Elly Quinlan (50:29):
Uh, easiest way would be research gate. I tend to keep my research gate profile up to date. So whenever I've got a new project out, I'll add it to there. And if, if there's any articles, people are interested in and they don't have access due to not being a student or in the field, just send me a message. I love when I get requests for my articles. And I think a lot of researchers do and people often don't think to ask, but please ask it. It is delightful.

Dr. Jasmine B. MacDonald (51:02):
Yeah. That's a really good point to make, amazing. Elly, thank you so much for, um, sitting down and having a chat with me today. It's been, uh, absolute pleasure and super interesting. So yeah. Thank you.

Dr. Elly Quinlan (51:17):
Thanks for having me

Dr. Jasmine B. MacDonald (51:21):
For those of you at home. That's all for today. Show notes for the episode can be found at www.psychattack.com. If you've enjoyed listening to psych attack, please rate it on your favorite podcast platform and share this episode to help other people find the show. If you have questions or feedback, you can reach out on Twitter at psych attack cast. Thanks for listening. And we'll catch up with you again. Next time.

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