How a Clinical Psychology Session could Look Like - How to Become a Clinical Psychologist (3)

The TV series "Adolescence," written by Jack Thorne and Stephen Graham and directed by Philip Barantini, is generating a lot of buzz. This might be the only show I've seen that portrays a psychological assessment session from start to finish. I'm impressed by how it conveys the session's intricacies, mirroring the possible realities of a psychological assessment. While clinical psychology training might instruct you on the tasks you need to accomplish in an assessment, this episode highlights numerous crucial aspects of reality. Spoiler alert below.

1.        Jamie frequently changed the direction of the conversation for various reasons, and Briony was determined to steer it back on track. Refocusing the conversation is a fundamental skill of all psychological sessions.

2.        Psychologists often appear to be friendly, not just to ease initial tension, but also to lower clients' defence. Briony attempted to engage Jamie by discussing "minor" topics, sharing some of her personal background, and even offering him a slice, all while having her own agenda and questions. However, this approach was transparent enough for 13-year-old Jamie to notice.

'Now you’re just chatting shit … Well, you are, because the first time you’re all, “if an adult guinea pig eats one of its kids, is that normal or weird?” And now you’re “What do you call bread?” … It feels like a trick.’

3.        Clients may challenge the psychologists' boundaries for various reasons, such as attempting to gain control, undermining the psychologists' authority, achieving their own desires, or even discrediting the psychologist.

“Can I see what you wrote? What you’ve written? … The lawyers have said you work for us.”

“What I’m in charge now, am I?”

“Can you get me out of this place?”

4.        Clients may question the psychologists' hypotheses and assumptions. Psychologists aim to ask questions to confirm the hypotheses they have about the clients' behavior. However, these assumptions might not resonate with the client. Even if they do, the approach could be perceived as intrusive and condescending.

When Briony asked questions about Jamie’s father, Jamie said "It just feels like you’re testing him”

“I thought we’d done talking about my dad… None of this is nothing to do with him”

5.        Some clients may question the psychologist's authority and professional integrity for various reasons, such as to evade difficult questions.

“The other shrink asks more normal questions, you know? … wanna know what he asks?”

“The other bloke is much more easy.”

“Are you allowed to ask these questions? ... Has Dillon passed these questions fit?”

6.        Some clients might question the psychologist’s use of language and professional responses.

“Aren’t you supposed to say I’m not ugly? … You don’t say the things normal people say.”

“Big words coming out now.”

7.        Some clients may exhibit threatening or challenging behavior, but it also presents an opportunity to observe how they manage their emotions. Jamie fluctuated between anger and vulnerability in response to Briony's attempt to set the limits.

Jamie stood up shouting “I don’t want to sit! … I don’t fucking wanna sit down! You do not tell me when to sit down! You do not control what I fucking. Look at me now! You do not control what I do in my life!”

"Look, no, fuck off! I didn’t fucking say that! You’re fucking putting words in me mouth! It’s a fucking trap in here"

8.        Clients usually understand that the psychologists have specific needs, which can be leveraged in a power struggle with the psychologists.

"Look at ya. All hopeful, like I’m gonna say something important.”

9.        What stood out to me the most during the session was how Jamie portrayed an incel treatment of Briony, despite his denial of being part of those “truth groups.” He considered himself ugly but longed for acceptance and affection, resorting to anger and threatening behavior.

“You’re dead pretty … You don’t think You’re pretty? You do think I’m ugly?”

“Did I scare you when I shouted? … I mean, I’m only 13. How embarrassing is that? Getting scared of a13-year-old.”

“Do you like me? … Because I like you. Not like that. Not fancying you. Just as a person. .. No don’t you even like me a bit?...How dare you!”

I came across the news that the series would be distributed to all secondary schools in the UK to help encourage discussions among young people on topics like the impact of social media, bullying, and family relationships.

Episode Three of this series should be used as a teaching material for all Clinical Psychology training programs. Jamie’s behaviour and responses can be analyzed moment-by-moment to develop hypotheses about Jamie's motives and psychological processes. It also facilitates brainstorming of immediate responses from psychologists. More importantly, it provides a platform for discussing how to maintain professional conduct when a psychologist's own emotions, such as anger, fear, shame, or vulnerability, are triggered. This is not confined to psychological assessments with involuntary clients; such situations can arise daily, even in treatment sessions with so-called voluntary clients. This episode presents numerous discussion points in clinical psychologist training.