Schubert Samantha, Monrouxe Lynn V, Buus Niels, Hunt Caroline
Clinical Psychology Unit, School of Psychology, Faculty of Science, University of Sydney, Camperdown, New South Wales, Australia.
School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
Med Educ. 2024 Mar;58(3):338-353. doi: 10.1111/medu.15200. Epub 2023 Sep 14.
Western mental healthcare system reforms prioritise person-centred care and require clinicians to adjust their professional positions. Realising these reforms will necessitate clinicians-including clinical psychologists-acquiring professional identities that align with them. Learners develop professional identities through socialisation activities: within interactional spaces such as supervision learners come to understand the self (clinician) and, by extension, the other (client). A clinician's understanding of who I am is intertwined with an understanding of who they are. Our study offers a moment-by-moment examination of supervision interactions of clinical psychology trainees to illuminate processes through which the identities of therapists and clients are constructed.
We examined how clinical psychology trainees and supervisors construct identities for themselves and clients in supervision.
We used positioning analysis to explore identity construction during interactions between supervisors (n = 4) and trainees (n = 12) in a clinical psychology training clinic. Positioning analysis focuses on the linguistic choices participants make as they position themselves (and others) in certain social spaces during everyday interactions. Twelve supervision sessions were audio recorded and transcribed. We found that clients were frequently positioned as fragile and subsequently analysed these sequences (n = 12).
Clients' identities were constructed as fragile, which co-occurred with clinical psychologists' claiming positions as responsible for managing their distress. Supervisors played an active role in linguistically positioning clients and trainees in this way. Trainees rarely contested the identities made available to them by supervisors.
We suggest that linguistically positioning clients as fragile perpetuates paternalistic clinical discourses that do not align with mental healthcare reform priorities. We make visible how this is achieved interactionally through language and influenced by organisational power relations. Intentional efforts are required to support the professional identity construction of clinical psychologists in ways that do not perpetuate paternalism. We offer recommendations for education and clinical practice to support these efforts.
西方精神卫生保健系统改革将以患者为中心的护理作为优先事项，并要求临床医生调整其专业角色。要实现这些改革，临床医生（包括临床心理学家）需要获得与之相符的专业身份。学习者通过社会化活动来塑造专业身份：在诸如督导等互动空间中，学习者开始了解自我（临床医生），进而了解他人（患者）。临床医生对“我是谁”的理解与对“他们是谁”的理解相互交织。我们的研究对临床心理学实习生的督导互动进行了逐刻分析，以阐明治疗师和患者身份构建的过程。
我们研究了临床心理学实习生和督导在督导过程中如何为自己和患者构建身份。
我们运用定位分析来探究临床心理学培训诊所中督导（n = 4）与实习生（n = 12）互动过程中的身份构建。定位分析关注参与者在日常互动中在特定社会空间中定位自己（和他人）时所做出的语言选择。对12次督导会议进行了音频录制和转录。我们发现患者经常被定位为脆弱的，随后对这些片段（n = 12）进行了分析。
患者的身份被构建为脆弱的，这与临床心理学家声称对管理患者的痛苦负责的立场同时出现。督导在以这种方式在语言上定位患者和实习生方面发挥了积极作用。实习生很少对督导赋予他们的身份提出质疑。
我们认为，将患者在语言上定位为脆弱会延续与精神卫生保健改革优先事项不符的家长式临床话语。我们揭示了这是如何通过语言在互动中实现的，并受到组织权力关系的影响。需要有意做出努力，以支持临床心理学家的专业身份构建，而不延续家长式作风。我们为教育和临床实践提供建议以支持这些努力。
