After my post on becoming a Trainee PWP was received so well, I thought that offering you an insight into a day on the job might be useful. Since I have been a qualified PWP at two very different services, I thought I would compile a compare and contrast. No two services are the same in how they operate and the types of difficulties they face so it is important to remember this when you are considering this role.
Please note that any identifiable information has been altered or removed to protect confidentiality of clients.
Monday morning: 9am
I arrive at a local community centre where I am based every Monday. I greet the receptionist and make myself the first tea of many from the kitchen. I set up my laptop and turn on my work phone, while they’re loading I get out my resources folder for the six treatment sessions I will have that day.
I change out of PJs, have my breakfast and take my first tea of many into the spare room where my desk and work laptop are. I turn on my work phone and load up my laptop. I check my diary for the four assessments and four follow up calls I have booked in.
The lovely receptionist knocks on my door to tell my my first client has arrived. I walk round to the front and greet them, a gentleman I have done three sessions with on behavioural activation. I make him a coffee while he completes the Minimum Data Set (MDS; known as the PHQ-9, GAD-7, phobia scales and impact scales). We catch up on how his week has been, review the homework task I set of scheduling in weekly exercise and identifying pleasurable activities he can engage in to lift his mood. He tells me about activities he is using to improve his wellbeing and what he is getting out of them. We spend half an hour mapping out further improvements this has had on his well-being and addressing any potential barriers. As this is session 4, we are over halfway and it is now time for him to take the reins. He sets himself a homework task and we end the session.
I pick up the phone and call a lady I assessed two weeks ago. She had demonstrated severe anxiety in social situations which seemed to relate to a history of bullying in childhood and in the workplace. I sent her self help leaflets after that appointment to give her a foundation for CBT for social anxiety. I also sent her the Social Phobia Inventory (SPIN) to assess whether she is in caseness for social anxiety. She answers the phone and I ask her to read out her responses to the MDS and SPIN. As I type them into the system it shows that her general anxiety score has reduced slightly but that her SPIN score is well within caseness. I ask her how she found the self help materials and she informed me that the meditation was very helpful for when she is overthinking but she is still afraid of having panic attacks in public. We talk about her week and I suggest strategies to keep her going. We agree to High Intensity CBT for her and I place her on the waiting list.
I have thirty minutes until my next session so I write up my notes and the questionnaire responses from the client. In my notes I cover the review of his well-being, the review of his homework task, main session notes including risk review and medication review, and the task I have sent him. As I took him to supervision the previous week for mid-point review, I don’t flag him for this week. I take the time to tidy up resources we used and respond to emails that came in first thing. I then review the notes of my 10:30 client and make sure my resources are ready for the session.
I call my first telephone assessment client of the day. I introduce myself and the purpose of the phone call, we address confidentiality and it’s limits and the structure of the session. She agrees and I ask her to grab a pen and paper for the MDS. After she notes down the answer key to the first two questionnaires, I take her through them and input directly onto the system as we speak. We reach question 9 of the PHQ-9 and she shares thoughts of self-harm occurring more than half the days. I carry out a comprehensive risk assessment and discover she has no plans, preparations or intent to act on such thoughts. She has a history of thinking this way but never acting. I inform her I will notify her GP after the session to allow them to support her and provide her out of hours contact numbers. We continue with the questionnaires and they show she has moderate-severe low mood and mild anxiety. I reflect this back to her in more colloquial terms and she agrees it is accurate. I then ask her to talk me through her main difficulty. We address her current situation, thoughts, feelings and behaviours. She has lost interest in hobbies and lacks motivation to connect with friends and colleagues. She establishes a goal for treatment and I thank her for her time and inform her I will send self help materials and questionnaires in a letter and we will follow up in two weeks. Luckily as I have been typing as we go, I can send the letter as we speak and book her into my diary. It’s now 10:45 and I have another follow up at 11; time for tea!
The morning continues in a similar pattern in both workplaces. One I will have two more clients at 10:30 and 11:30 for low intensity CBT and the other I will do another follow up at 11 and another telephone assessment at 11:30. I then break for lunch around 12:30 and resume clinical work around 1-2pm.
Monday afternoon: 2pm
Treatment session no. 4: I spent the last thirty minutes writing up my supervision notes for the next day. I have three assessments to discuss, today’s 11:30 client to take to midpoint review, and a few from the end of last week that seem to have dropped out of treatment. Now my 2pm client has arrived. A young woman who is affected by constant worry regarding anything and everything. It’s a first treatment session so I take my time to reassess the difficulty as she has been waiting for some weeks and things may have changed. Then I formulate her difficulties with her and establish goals for our sessions. She wants to be able to get through her work day without being distracted by worry as her manager has noticed she is taking too long to get things done. We establish how her thoughts are therefore affecting her behaviours and how this has an impact on her thinking as a result of her manager picking her up on it. I send her away with her own blank formulation to fill in and we agree to see each other in two weeks time.
Telephone assessment no. 3: working from home means I can get so much more done and actually have time for myself. I watched Netflix as I ate my lunch and went for a walk before I come back to do my 1:30 follow up. Being able to type and talk simultaneously means my notes are done a lot faster, too. I phone my 2pm assessment and carry it out as I did my previous two that day. However, this individual discloses frequent suicidal thoughts and is currently at home alone. They rate their intent to act on such thoughts as a 7/10 and when asked how they would do this they disclose that they have access to prescription medication they have been holding onto. I contact my supervisor via email while on the phone and inform them I am doing so. They are calm and understanding, grateful for my help and diligence. We decide to call the Crisis team on their behalf and they agree to carry out an assessment ASAP. The client is stepped up to their care and handed over immediately. I notify the GP and write up all notes. I agree to contact the client again in a week to carry out the assessment once their risk is being managed. They book in with me and I end the call.
I then continue to offer treatment sessions at 3 and 4pm, and telephone assessments and follow ups at 3pm and 4pm. When it comes to why I work the way I do, the left hand common is instructed to me. I’m told to do six treatment sessions at that venue and I can pick whichever time slot between 9-5. The right hand column is completely of my making. I was instructed to do eight assessments a week and I decided to do four a day from home on Mondays and Tuesdays. I also fit in my telephone follow ups and cCBT from home on these days. This allows me to do as much treatment as I can to meet my 20 contacts on a Wednesday-Friday. My second workplace is much more relaxed but there is a lot more to do, so it’s swings and roundabouts.
I hope this article helped provide a glimpse into what it can be like working for a PWP! If you have any questions or want to see more content like this then let me know in the comments!