Embracing the Noise as a Clinical Psychology Trainee

By: Ruben Tinajero, MS

Five years ago, when I first came to Salt Lake City to obtain clinical psychology training at the University of Utah, I was excited about the opportunity to obtain research and clinical training in health psychology. During my second year in the program, I completed my first practicum training at the University Counseling Center where I provided assessment and intervention services to university students. Training alongside the outstanding professionals at the University Counseling Center convinced me that I had indeed made the correct decision in pursuing graduate training in clinical psychology. At the counseling center I was able to conduct therapy sessions and complete my notes in a quiet, calm environment that was a short walk away from the building that houses the psychology department. Additionally, my supervisors were faculty members in the psychology department that knew me well. Before I completed my counseling center practicum I received my first opportunity to train in primary care, specifically in co-leading the Weight Loss Group at the Sugarhouse Clinic. Three years later, I recall my experiences training in primary care as the most memorable and enjoyable in my training at the U.

As a health psychology clinical student, I received didactic training in the intricacies of working in behavioral health settings. We discussed how to best work collaboratively with other healthcare professionals and the adjustments one needs to make in order to thrive in complex medical settings. Thus, I expected that my experiences training at an academic medical center would be different than training at the University Counseling Center. Indeed, I knew I was in a different world the moment I stepped foot in my first primary care practicum training. Medical assistants were moving from one place to another, patients were physically ill in the waiting room, babies were crying everywhere, and the attending room was buzzing. It was an intimidating environment at first, yet over time I got to know many members of the primary care team. Each day, I saw examples of healthcare professionals supporting one another to provide the best care for patients and for coping with the stress of working long days. Soon enough, I began to feel comfortable training in primary care settings because I enjoyed working as a member of a healthcare team.

During my time in primary care, I had the opportunity to work with many patients in both individual and group settings. The training experience that helped me grow the most as a clinician was providing point of care consultations to patients. For such consultations, I would identify patients who may want to address behavioral or mental health concerns before or after meeting with their provider. These consultations needed to be short (around 10 minutes) and meet the varied needs of patients. One of the more challenging components of these consultations was the fact that most patients did not expect to see me during their visit. As a result, I needed to quickly introduce myself, assess the patients concerns, provide them with education about their mental health difficulties, come up with a plan to address their mental health problems, all while earning their trust. Over time, I learned that these consultations were most effective when I listened to and validated the emotions of patients, and when we discussed and practiced specific skills that they could use to improve their mental health. Such skills included progressive muscle relaxation, mindfulness, grounding exercises, behaviors to promote good quality sleep, and behavioral activation. Encouraging patients to use these skills allows them to feel like they can play an active role in promoting their mental health and their overall well being, often while they wait to see if their SSRI medication will also help them. Ultimately, promoting self-efficacy is an important step in helping patients address their mental health difficulties.

As I prepare to go on my internship, what I will miss the most about Utah are the people that have helped me grow as a person and clinician, including my friends, professors, supervisors, and medical team colleagues. Throughout my life, I’ve always needed a quiet room to study and do my work. Now, I feel like I work best in the busy and noisy rooms of primary care clinics.

Ruben Tinajero, MS, is a clinical psychology practicum student at the University of Utah in Salt Lake City, UT.

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