Whilst hiring APs to run a psychological service can be a great solution to the shortage of Psychologists in the UK, that also carries challenges which need to be addressed. 

With varying levels of expertise, APs strive to provide quality care while grappling with self-doubt and external constraints. Additionally, insufficient job opportunities and spots on the doctoral degree means a shortage of qualified Psychologists. 

In total, the route to becoming a psychologist is longer than that of a medical doctor. Training to become a Psychologist typically takes several years and requires investing time and money into education. In addition, Psychologists have to complete hours of low-paid work to gain experience in the field. In the United Kingdom, this involves:

3-4 year bachelor’s degree → 2 + years of work experience → 1-year master’s degree (optional) → 3-year doctoral degree 

Most APs have completed their bachelor’s degree, some even their master’s (not mandatory) and several years of work experience. What is left, is 3 more years. At RESET, we believe that APs are competent and equipped to work on-site independently. Given that the AP has previous experience and training, all they need is someone to help unlock their inner resources to rise up to the challenges.

We understand the uncertainties or concerns with hiring only an AP within your own service, therefore, in this blog, we share 5 risks and explore strategies to overcome these challenges.

1. Some countries might have particular legal and ethical requirements

In some jurisdictions, there are legal and ethical constraints on what APs can do without direct supervision on-site. This can limit the range of services they can provide independently, so it is important for you to evaluate the service’s specific requirements, resources, and client group while ensuring compliance with relevant regulations and ethical standards. For support with this, you can read up more on the British Psychological Societies (BPS) guidance for what an AP’s job profile looks like. The BPS is the professional body for Psychologists in the UK. The BPS plays a crucial role in advancing the field of psychology, promoting ethical and evidence-based practice, and providing resources.

I state “within the UK” as in most countries, registered Psychologists do not have to complete a doctoral degree, but rather a master’s – so it is important to consider legal requirements to practice depending on which country you are based. 

Generally, Assistant Psychologists have been through extensive education, various work experience, and training, therefore, they are equipped to provide a range of services, such as assessment, intervention, and care planning. However, Assistant Psychologists do not have the same level of training (3-4 year Doctoral degree) as a  Psychologist registered within the UK. 

2. APs are prone to burnout due to a heavy workload

An AP may face a heavy workload if they are the primary mental health professional on site. From managing and delivering therapeutic interventions to organising staff reflective practice, APs are prone to burnout. If the primary AP experiences burnout the quality of care will likely be reduced and patient satisfaction will decrease. 

To mitigate this risk, mental health services should carefully assess their caseload, the complexity of cases, and their staffing needs to ensure that the AP can meet day-to-day demands. An AP’s work-life balance needs to be respected by the service. 

3. Without supervision, APs might struggle which in turn can impact the quality of care

APs require supervision from licensed Psychologists or other experienced professionals. If there is a lack of experienced supervisors on site, it can hinder the AP’s professional growth and may impact the quality of care. 

Additionally, the AP may face challenges without having access to a supervisor on-site if they require support during patient sessions due to a crisis for example. Mental health services often encounter crises where immediate and expert interventions are necessary. Some APs may have vast experience with managing risk but even then in complex cases, an experienced professional may be required. 

To overcome this, if there is only an AP on-site, another professional working within the service should be appointed if the AP requires further support during patient interactions. 

4. Some APs are new to the profession and lack expertise

As stated, some APs may have already had vast experience working within the mental health sector, but some may have had less training and experience which makes it difficult for them to provide the best possible care.

To overcome this, it is important that your organisation provides comprehensive training, support and access to resources for APs to continuously build on their knowledge, and become familiar with the client group and day-to-day work. 

5. Doing a job usually reserved for fully qualified Psychologists can trigger APs’ Impostor Syndrome

Speaking as an AP myself who worked independently within an addiction service, my impostor syndrome was heightened. Impostor syndrome can be described as feeling “like a fraud”, experiencing self-doubt and viewing yourself as incompetent. Impostor syndrome is a common feeling, experienced by different people across different professions. 

Due to the heavy workload and my own perception that “I am not competent enough” or “I am not qualified enough” (due to not having completed my doctoral degree yet), I felt like an impostor. This feeling reduced my self-esteem, increased anxiety, underestimated my skills and impacted my relationships with colleagues. However, regular supervision created a safe space for me to discuss doubts and concerns, with my supervisor providing feedback, guidance, and reassurance. 

Although a personal experience, perhaps, impostor syndrome is being experienced by APs who are working on-site independently, and all professionals for that matter. This highlights the importance of assessing the well-being of your employees and providing adequate support and training. 

Still wondering if you should have an AP running your Psychological Service? Here’s what you can do

We have addressed the crucial decision of having only an AP on-site and the associated benefits and challenges.

Throughout, we have shed light on the potential risks of hiring only APs. We also argued that what makes a competent professional is not the doctoral title of psychology but, rather, their competence, training and experience.

At RESET, we understand the hesitations around APs working as sole practitioners and we aim to provide insights and guidance so, if you are still wondering whether you can have an AP run your Psychological Service, here are four things you can do:

• Evaluate your specific requirements, resources, and client group
• Consider legal and ethical standards in your country 
• Ensure your APs receive the support and training they need and embrace their potential 
• Recognise APs capabilities and address the outlined risks

If you are looking for ways to reduce the revolving door, improve patient adherence or provide a Psychologically Informed Environment – PIE, you can take our 3 min free quiz and receive a detailed report to help you take the first steps in creating a PIE in your workplace.

Msc Saiyuri Naidu is a Senior Assistant Psychologist at the RESET Health Group and an MSc Clinical Psychology Graduate with a special interest in trauma and how this can affect an individual’s mind and body.