Career Spotlight: Clinical Psychology

What drew you to the field of psychology?

Leslie Roos: I was first interested in visual arts and environmental science and when I tried a few different internships, I realized that I really liked working with people. So, I became interested in psychology for the opportunity to work more directly with clients. I also think lots of folks experience mental challenges or notice them in their community and I became really interested in learning more about different ways to support people. I wanted to help people reach their own goals, as mental illness often gets in the way of people's ability to achieve things that they hope to aim for in their lives. 

Emily Cameron: I was first interested in biology, and went to university to study that. I hadn't been exposed to psychology at the high school level, so when I got to university and took a psychology course as an elective, I became very interested in human psychology and this interaction between our behaviour and our mind. So, I changed my major to a combined biology and psychology major and focused on psychology throughout my undergrad. And at the same time, I was working with youth in a Big Brothers Big Sisters program, and I really loved spending time with them and working through the issues they were facing. I realized I was interested in pursuing clinical psychology in graduate school, and in particular working with youth and families to support child development.

Dr. Roos, what advantages do you see to being in research, specifically in clinical psychology, in comparison to other medical fields?

LR: I think research in psychology is at a really exciting place, because 50 years of research shows that with concerted efforts, we have a number of evidence-based services to improve mental health and wellbeing. At the same time, talking to folks working in the mental health field, most people would agree that it's challenging to improve mental health as much as you want to. So, I think there's a real opportunity to sit on a solid foundation and improve things beyond the status quo. A lot is known but there's a lot more to know. It’s also really inspirational to be working with families and seeing how hard they work towards improving their own being and the wellbeing of the people around them, and also gaining new insights about why maybe the program that you're working with doesn't quite meet their needs. So I think we draw a lot of ideas in our research about new directions or things that need to be adjusted based on working with clients directly.

Dr. Cameron, can you explain some specifics of university when going into psychology, such as how many years of university one generally needs for the field, etc?

EC: I went to graduate school in Canada and at that time, an honours degree was required. So that is at the Bachelor’s level, and typically, it's an extra year. But it's a specialized year of research where you write a thesis and conduct a research study, giving you exposure to that research experience. I did my degree in four years and added on that honours year, totalling five years, but it may take shorter or longer depending on how someone’s approached it. For getting into clinical psychology, in particular, honours degrees are pretty normative, but having some additional lab experiences can be really important too. So it’s good to get involved in a research lab, which might look like helping to collect data or recruit participants. I got involved in a lab in my third year of university, so I had two years of research experience before my honours degree. Getting involved helps to both set yourself up for success in your honours year and have those useful experiences that might result in a publication. I also had a number of poster presentations that I was able to present at several conferences. In the Hearts and Minds lab, that's the approach we take with undergraduate students - helping mentor and train them across different levels to be involved in conference presentations and manuscripts. 

One does not go to medical school for psychology either. What is more important is having some prerequisite courses. So you could not have a psychology Bachelor's degree, but could have taken some of the courses that would be relevant, such as statistics and psychology. If you get a Bachelor's degree and then want to update your courses to be able to go to graduate school, that's okay too. But there's no medical school, that would be a different route. So Dr. Roos and I both have PhDs or Doctorates of Philosophy, and not medical degrees.

What did you personally do in high school and undergraduate school to help prepare you for this field and what obstacles did you face during your education? 

EC: Some of my peers in university had been able to take psychology in high school and had a little more certainty on the direction that they wanted to take. But I didn't decide wholeheartedly that I was going into clinical psychology until my fourth year of my undergraduate degree. In addition, I had lots of different opportunities to volunteer and create a resume of having experiences. That being said, there wasn't anything that I did in high school other than what was needed to get into university.

LR: My biggest suggestion would be that it's really challenging, from classes alone, to know what type of career path you might be happy doing. Although the classes are important, I would consider other experiences, like joining a research lab to learn about jobs related to the field. I tried to do two other career paths before I realized that I really loved psychology. So I spent a couple summers in high school taking notes of frozen fish guts with the Experimental Lakes Area, and I realized that I didn't want to do that. And then in college, I took a lot of art classes and although I really loved it, I wasn't great at it and I failed the class. It was really important for me to have those experiences of being unhappy in what I thought I wanted to do, to push me to keep trying to find opportunities to land on something that I really wanted to do. And I found that in psychology - I liked the classes, and I also did an independent seminar with a professor that I liked. After college, I found it really beneficial to work for a year in the mental health field. I did clinical interviews with people who are managing mental illness and homelessness and that was really impactful for seeing how improving mental illness can allow people to take concrete steps towards their goals. So trying out a lot of different things is the most important advice I would have for students trying to identify a career that they're going to feel satisfied with. 

Like you mentioned earlier, both of you are involved in the Hearts and Minds lab at the University of Manitoba. Dr. Roos, what has been your experience like co-directing such an interdisciplinary team?

LR: It's super fun! We're getting the opportunity to work with students at every level, and having a co-director who is a developmental cognitive scientist is really wonderful for providing new perspectives and new methods to the study of mental health and family wellbeing. Working with young kids, it's not the type of research where one person can do an assessment quickly. It takes a team approach; so when we have families come into the lab, for example, we have four research assistants who are there to meet them and to help out with childcare, with explaining the process, and with helping manage some of the physiological recordings that we do, like measuring heart rate in the autonomic nervous system or brain rate brainwaves with EEG. I would say it's a nice opportunity to work with people who have different interests and different skill sets under the larger umbrella of wanting to support family wellbeing.

What are some projects that you have been or are currently involved in and what are some of the most important takeaways you took from them?

LR: I can talk about some of our more basic science research. One of the projects that we're doing is trying to understand how parents support children's ability to manage challenging experiences. In order to do that, when we bring families into the lab, we have kids do challenging tasks, where they can't win at a game for example. They do receive a prize at the end of the visit, but for a 10-minute period in the middle, they think that they haven't gone fast enough in this challenging game to win their prize. One of the things that we look at there is how parents use different strategies to help their children cope with that frustration or disappointment. It's been really informative, because there's so many different ways that you can, on the outside, help kids manage their distress, like distracting them, saying it doesn't matter, giving them a hug, or starting another task. But one of the things that we found is that, at the physiological level (kids’ heart rate and stress hormones), the role of physical touch and comfort from parents is most important for helping their stress go down over time. That's been really interesting to me in our clinical work because it has shown parenting strategies that support the child. 

EC: I can speak to the more clinical interventions that we're working on. One of the overarching ones that has been parsed off into a couple other projects is called the Bridge Parenting Program, which Dr. Roos created. It is a combination of mental health interventions for mothers of young children with a mental health concern, primarily depression. It works to both improve their symptoms of depression, as well as directly use those strategies to improve their parenting. One thing that we know is that mental health, and in particular depression, really impacts parenting ability or behaviors in that parent-child relationship, so we are looking at improving this intergenerational transmission of mental health. As a result of some of the work that we've done to adapt this program this year, we are launching a parenting skills training program in January to help with parenting stress - not looking at mental health specifically, but acknowledging that there is widespread parenting stress as a result of COVID right now. We have pre-recorded videos that we're going to use as an intervention to look at whether they will help improve parenting stress in the context of the pandemic, and we're calling this program the Space Parenting program. Lastly, we are developing a mental health app and parenting skills training for mothers, called Beam. We also have a grant right now from the Movember foundation and we're hoping to adapt that to fathers so that we can really help both parents manage both their mental health and parenting.

What is a day in your life? What do you do on a regular workday and could you tell us how your day has changed due to COVID-19?

LR: I have two young kids and two dogs so my morning is normally spent getting people dressed, fed, and showered, before getting going in the morning. And then typically, I would go to work at the university and I might have a couple of meetings in the morning with students. I also try to have some hours blocked off to work on a writing project, which could be writing up a publication, working on a grant, or editing student work. In the afternoon, I might have a faculty meeting to talk about student admissions this time of year. I may also teach a class, so one of the courses that I'm currently teaching is program design and evaluation for school psychology and clinical psychology students. Later on, I will wrap up for the day and answer a whole bunch of emails, probably around 30 or 40 a day. I head home and try to get in a yoga class if I can before picking up the kids, doing dinner, and having a relaxing evening. I work in the evenings about every other evening to do some work if I haven't had a chance to get things done in the day. 

EC: I am an associate postdoctoral fellow, which means that I've completed my PhD, I've done my graduate training, and I'm doing a research specialty with Dr. Roos. So, I am on a trajectory to hopefully having a faculty position just like Dr. Roos, in which my day would look very similar. But, a lot of my day, especially with COVID and not being able to go to the campus, is contingent on my own scheduling. Just like Dr. Roos, I generally start my day with some meetings. I'm supervising a number of honours students and graduate students on their honours student theses, so after several meetings, I block time to work on publications or research or data analysis. I am one of the facilitators on our intervention study, so I have two afternoons where I'm leading group therapy. And then we have some team meetings for various projects throughout the week, so whether that's in combination with Dr. Roos, or as the lead on those studies, I'm managing several projects. As mentioned, I am able to dictate when I'm finishing up for the day. There's fluctuations in schedule, so if we're in the middle of writing a big grant or getting a big paper out, things will be busier. But for the most part, the benefit of this job is that you get to make those decisions.

What is the most exciting part of your day?

LR: The most exciting part of my day is probably meeting with students to hear new results from a project that they're working on, or hearing about some of their learning. Working with families and people directly is a little bit different than a laboratory-based setting where you might not know the results until the end of the study. But you often have really interesting observations about how people are managing challenging situations. An example of that was the observation from some of our student research assistants, that one of the most effective ways that kids seem to cope with some of the challenging tasks are through self talk. So they'll be doing a task that they can't do, but they'll say “That's okay, you win some you lose some! You can try again later!”. So I love hearing about insights from people who are hands-on in the research. When I'm working clinically with a client and they make major progress, that's also shared excitement for me. 

EC: I echo a lot of that. I am also a senior clinical associate at KIDTHINK Children's Mental Health Services and I work there about half-day a week. When I'm working with clients directly, I love hearing about their small wins that they want to tell me about over the last couple weeks. Other than that, I love statistics and data analysis and if I have a chance to sit down and work through the data and do some analyses to get those results, that's exciting for me as well.

Dr. Roos, is there anything that surprised you when you first started out as a clinical psychologist?

LR: One of the biggest things in starting to hear people's stories and hear about the types of things that contribute to mental wellness or challenges is all of the things that people manage in their day-to-day lives that you don't know about. That was surprising early on, and the idea that everyone's doing the best they can in their circumstances continues to impress me today.

From your professional stance, how much more important do you think mental health awareness has become amidst this pandemic? Do you have any advice for those who may be struggling during periods of isolation?

EC: Early on, there was a very big push in the media, as lots of people saw the potential impact that the pandemic could have on mental health. We have seen that in a lot of the work that we've been doing as well. For instance, instead of mental health concerns being prevalent in one in 10 mothers, it's gone up to four in 10 mothers. So, there's certainly a new subset of people who haven't had mental health concerns in the past and who likely aren't accessing support or do not know how to access it. Some of the research we've done has also identified that a lot of people use the internet to find mental health information without actually seeking professional help, and only about 25% of the people who have mental health concerns are actively seeking support. So, while I think there's been a lot of media reports of the importance of mental health, there's still a lot more that needs to be done. And the reality is that right now, we don't have the same kind of widespread support to offer. So, the Beam app, which is the app for mental health, and the Movember foundation app we are hoping to develop, are direct results of the pandemic. In the current situation, a lot of what we're trying to do comes from the fact that it's not necessarily enough to just have awareness, but we also need solutions to help manage those increased needs.

LR: Mental health has come to the forefront of many people's minds during the pandemic, particularly with social isolation. At the same time, I think it's important to recognize that mental health challenges can look different person to person. One of the findings that was really striking in our data is that although we do see more problems across the board on average, it looks like the people who are experiencing more severe difficulties are folks who have previous experience of mental illness. It is also important to recognize that there are lots of programs out there, but they don't help everyone the first time, and any given program might not be the right match for someone. So, I think encouraging people that with the right match and with the right additional support, it can be possible to improve mental health, is important.

What exactly is anxiety and what does it take to medically diagnose someone with it?

EC: Anxiety looks like clinical levels of worry or nervousness. There are different types of anxiety, but to group them all together, the symptoms look like constant worry that’s causing a lot of distress. Performing in front of people or public speaking is a very common worry. It could be more specific, like a phobia, such as being very afraid of spiders, to the point where maybe you can’t stop thinking about them. But oftentimes when we mention worry in our studies, we’re talking about more of a general worry. Rather than diagnosing people with anxiety, we look at how many symptoms they have and if that is reaching a threshold that would give them a high probability of meeting a diagnosis. It is important to note that a diagnosis isn’t necessary to be able to get treatment for anxiety. So whether or not you meet the criteria in our manual of what anxiety is, you can still get treatment if you have symptoms that are distressing or impairing in some way. 

What kinds of challenges do you encounter and what kinds of decisions have you had to make?

LR: It’s really challenging when you feel like the services you’re providing aren’t meeting someone’s needs enough to see a big improvement in mental wellness. That may just be because there’s more systemic issues at play, so factors like racism or poverty. In those situations, we typically advocate for more external support and other community resources that might help meet their needs. In the big picture, some of my hopes are for the province and for Canada to take more of a stepped care approach to mental health. That means providing evidence-based clinical services to anyone who’s not only experiencing psychological distress, but also in need of income support, housing support, or educational support. Overall, we need a more wide-scale investment and the research to learn about who needs what.

EC: I do a lot of work with children and youth clinically and working with parents is often very important, because everyone in a household is interacting with each other and there's lots of different things at play. Sometimes it can be important to talk to the school and how they can support the youth. So, while we often get one individual who needs to be supported, it’s helpful to bring in other resources.

Dr. Roos, what do you think is an important skill that psychologists should possess and what skill do you possess to make you successful in this?

LR: One of the things that I think is really important for psychologists to hold on to is called dialectical behavior therapy. It's this idea of being able to empathize with a person for where they're at and being able to validate the emotions and challenges that they experienced. I can be very problem solving oriented, and it took me a long time to realize that sometimes, it might not be possible to change where someone's at right now. So my task as a clinician may just be to accept that what someone's going through is incredibly hard and unfair. This helps me to think about what might help them tolerate that with a little bit less pain, or which people with shared experiences can help them walk through that discomfort. It's important to be able to think this way to understand what might be most helpful for an individual. 

Dr. Cameron, what are your long term career goals as a psychologist? 

EC: My long term term career goal is to be in the position that Dr. Roos is in. So, I'm hoping to work as a professor at a university where I can continue conducting interventional research and working with parents and families to support child wellbeing. One of the great things in my role is that I can spend time with clients directly and work to improve mental health. So, I’m aiming to do a lot of what I'm currently doing, with a shift to directing a lab down the line.

What advice would you give to a high school or university student who is unsure of whether or not psychology, and to a larger extent the health sciences, is the right fit for them?

LR: My biggest suggestion would be to try it out. So volunteer in a lab or at the hospital, and learn about what you love. At an intellectual level, you need to be inspired, but you also need to be inspired and energized by everyday work, and the best way to get that experience is by volunteering and working in those areas. There are also a lot of different types of funding support at the University of Manitoba that can provide paid positions during the year for students. Receiving a fellowship like that can really open the door for more full-time focused attention and experience. 

EC: There's nothing wrong with starting university with one idea and switching it several times. At one point, I was going to be a chemistry major and at another time, I was going to add a second major in computer science. The whole point of university is to explore and figure out what it is you love. Lots of people start university with a cookie cutter approach of what they think they need to end up with, but it's also great to try lots of things and make several shifts if that's what's best for you.