Psychologists’ Experience Of Uncertainty Throughout Their Career: Narrative Analysis

Psychologists face high levels of uncertainty due to complex client presentations, subjective diagnostic processes, and the inherent ambiguity in mental health treatment.

Challenges include vague complaints, comorbidity, and ethical dilemmas. Uncertainty tolerance is crucial for effective practice and professional development.

However, research on how this tolerance develops over time is limited and inconsistent, with some studies showing increased tolerance with experience, while others find no difference.Copy

Fewings, E., & Quinlan, E. (2023). “It hasn’t gone away after 30 years.” late-career Australian psychologists’ experience of uncertainty throughout their career. Professional Psychology: Research and Practice, 54(3), 221–230. https://doi.org/10.1037/pro0000511

Key Points

1. The experience of uncertainty among psychologists evolves throughout their career stages, with early career being the most challenging and late career characterized by greater acceptance.
2. Late-career psychologists develop various strategies to manage uncertainty, including self-management techniques, working in niche areas, and therapeutic disclosure.
3. Educational programs may not adequately prepare psychologists for the inherent uncertainties in their profession.
4. Factors like career stage, therapeutic orientation, and self-management strategies significantly affect how psychologists experience and cope with uncertainty.
5. The research, while enlightening, has limitations such as a small sample size and potential self-selection bias.
6. Understanding uncertainty in psychological practice is universally relevant for improving training, supervision, and clinical outcomes.

Rationale

The study aims to address a significant gap in the literature regarding the experience of uncertainty among late-career psychologists.

While considerable research has been conducted on uncertainty in early-career healthcare professionals (Nevalainen et al., 2010; van Iersel et al., 2019), comparatively little is known about how experienced psychologists navigate uncertainty throughout their careers.

This study is particularly important given that the nature of psychological practice is inherently marked by uncertainty and ambiguity (Omand, 2010; Pica, 1998).

Understanding how seasoned professionals manage uncertainty can inform training protocols, supervision practices, and personal development strategies for psychologists at all career stages.

Method

The study employed a qualitative research design using narrative inquiry.

This approach was chosen to understand how late-career psychologists make sense of their experiences with uncertainty across their professional lives. Semi-structured interviews were conducted via Zoom video conferencing.

The interview protocol was designed to elicit broad narratives about participants’ experiences of uncertainty throughout their careers, with probes used to explore specific aspects such as changes in uncertainty over time and strategies for managing uncertainty.

Sample

Participants included 11 Australian psychologists aged between 55 and 81 years (M = 62.7), with nine female and two male participants.

They had an average of 33.4 years of practice experience post-registration (range: 26–45 years, SD = 5.7).

The sample consisted of four general psychologists and seven psychologists with various areas of endorsement (clinical, counseling, community, and organizational).

Results

The study identified six overarching themes:

1. Uncertainty Starts in Early Career (10/11 Participants)

The vast majority of participants reported that uncertainty was highest and most uncomfortable in the early stages of their careers.

This uncertainty was primarily related to perceived limitations of knowledge, lack of confidence, and heightened feelings of responsibility.

Early career uncertainty was often experienced as threatening, leading to anxiety, fear, and self-doubt.

“There’s probably that early phase where uncertainty was a threat. And uncertainty felt overwhelming, and uncertainty feels like a little bit like being on a precipice without any handrail. That was my experience.”

(Sarah)

Subtheme: Education Fails to Adequately Prepare for Uncertainty (5/11 Participants)

Several participants felt that their training had not prepared them for the uncertainty they experienced in early career, creating a gap between academic knowledge and real-world complexity.

“That’s part of my problem with the clinical psychology training. It tries to give people a false sense of expertise and, you know, specialty and certainty and we’re not brain surgeons.”

(Amy)

2. Uncertainty Ebbs and Flows in Midcareer (9/11 Participants)

Participants reported that uncertainty continued to be present in their mid-careers but in a fluctuating manner.

Uncertainty often increased during career transition points, such as changing roles, starting a new specialty, or entering private practice.

It does vary with how long you’ve been in, how far you’ve gone up and sideways what the role is at the time, who you are working with. It’s a constantly moving beast.”

(David)

3. The Ongoing Presence of Uncertainty in Late Career (10/11 Participants)

Uncertainty persists into late career, but its nature changes. Late-career uncertainty often relates to keeping up with changes in the field, ethical issues, financial pressures, and business uncertainties.

“As you age there’s the uncertainty of whether you’re abreast of all the things you’re meant to know about. You know, latest rules on what you’re meant to notify, changing systems, latest Medicare requirements…”

(Amy)

4. Uncertainty Feels Less Threatening in Late Career (10/11 Participants)

Most participants reported feeling more confident in their knowledge and skills in late career, which offset the impact of uncertainty.

They described being able to sit with uncertainty without experiencing the same levels of anxiety as in early career.

“I’m much more capable now- of when something presents to me that I have no idea about- to trust that eventually I’ll figure it out and not worry about it too much.”

(Sarah)

5. A Variety of Strategies Are Developed Overtime to Buffer Against Uncertainty (11/11 Participants)

Participants described developing various strategies to manage uncertainty throughout their careers. These strategies evolved over time and included:

Subtheme: Study, Skill Development, and Therapeutic Model (8/11 Participants)

Further study and skill development were used to consolidate knowledge, particularly in early and mid-career stages.

“The impetus to work very hard on those technical skills early, so that even when I was self-doubting, I could say ‘I know I can do this because I’ve done this training’.”

(David)

Subtheme: Intrinsically Self-Soothe, Self-Talk, Self-Management (10/11 Participants)

In late career, participants developed skills to intrinsically manage uncertainty through techniques like breathing, self-talk, and acknowledging feelings.

“A lot of the skills are self-management. Trying to regulate my own mood, especially anxiety. To reassure myself.”

(Sally)

Subtheme: Finding a Niche (6/11 Participants)

Some participants reduced uncertainty by setting clear parameters around their areas of expertise and working within a niche area.

“When it comes to not knowing what to do, I don’t encounter that often now, if that makes sense. Because I’m in a niche and I’ve learnt the niche.”

(Lisa)

Subtheme: Uncertainty Is Disclosed for Therapeutic Benefit (10/11 Participants)

Many participants reported using therapeutic disclosure of uncertainty when deemed beneficial for clients.

“I’ve become more ‘it’s okay to say I don’t know’ or ‘I don’t deal with that’ or ‘I’m not sure how we’re going to, you know.'”

(Laura)

6. Supportive Environment (11/11 Participants)

All participants emphasized the importance of a supportive environment in managing uncertainty. This included peer support, supervision, and a positive work environment.

The nature of support shifted from formal supervision in early career to more peer consultation in late career.

“I guess them [work colleagues] and other people offering support and care and you feel like there’s safety or something. It adds a buffer to uncertainty. It’s like, if I fall, something might catch me, because otherwise, I’m in free fall.”

(John)

Insight and Depth

This study provides valuable insights into the long-term trajectory of uncertainty experiences in psychological practice.

Uncertainty is highest and most uncomfortable in early career stages, often related to fears about knowledge, confidence, and responsibility. This can lead to anxiety, burnout, and career abandonment.

Educational programs often fail to prepare psychologists for uncertainty, instead training for certainty. This leaves new practitioners unprepared for the complexities of real-world practice.

In mid-career, uncertainty continues but causes less distress. It fluctuates, especially during career transitions, which can still lead to stress and psychological distress.

Late-career uncertainty persists but is managed differently, focusing more on self-management strategies rather than knowledge acquisition. This represents a shift from trying to eliminate uncertainty to managing its presence.

The research also uncovers the potential benefits of embracing uncertainty, suggesting that it can be a catalyst for personal and professional growth when approached with the right mindset and strategies.

Strengths

1. The study employed a narrative inquiry approach, allowing for rich, in-depth exploration of participants’ experiences over time.
2. The sample included psychologists from various specialties, providing a broad perspective on uncertainty in different areas of practice.
3. The research addressed a significant gap in the literature by focusing on late-career psychologists.
4. The study used member checking to enhance credibility and ensure accurate representation of participants’ experiences.

Limitations

1. The small sample size (n=11) may limit the generalizability of the findings.
2. The study focused solely on Australian psychologists, potentially limiting its applicability to other cultural contexts.
3. There may be self-selection bias, as participants who volunteered for the study might have been more comfortable discussing uncertainty.
4. The retrospective nature of the study relies on participants’ memories, which may be subject to recall bias.

Clinical Implications

The findings have several important implications for psychological practice and education:

1. Training programs should incorporate explicit discussions and exercises related to managing uncertainty to better prepare new psychologists for the realities of practice.
2. Supervision and mentoring programs could benefit from including strategies for managing uncertainty at different career stages.
3. Continuing education for mid- and late-career psychologists should address evolving sources of uncertainty, such as ethical dilemmas and business challenges.
4. The positive framing of uncertainty as an opportunity for growth could be incorporated into professional development initiatives.
5. The study highlights the importance of self-management strategies and peer support in managing uncertainty, suggesting that these should be emphasized in professional practice.

References

Primary reference

Fewings, E., & Quinlan, E. (2023). “It hasn’t gone away after 30 years.” late-career Australian psychologists’ experience of uncertainty throughout their career. Professional Psychology: Research and Practice, 54(3), 221–230. https://doi.org/10.1037/pro0000511

Other references

Nevalainen, M. K., Mantyranta, T., & Pitkala, K. H. (2010). Facing uncertainty as a medical student—A qualitative study of their reflective learning diaries and writings on specific themes during the first clinical year. Patient Education and Counseling, 78(2), 218-223.

Omand, L. (2010). What makes for good supervision and whose responsibility is it anyway? Psychodynamic Practice, 16(4), 377-392.

Pica, M. (1998). The ambiguous nature of clinical training and its impact on the development of student clinicians. Psychotherapy, 35(3), 361-365.

van Iersel, M. B., Brantjes, E., de Visser, M., Looman, N., Bazelmans, E., & van Asselt, D. (2019). Tolerance of clinical uncertainty by geriatric residents: A qualitative study. European Geriatric Medicine, 10(3), 517-522.

Keep Learning

Suggested Socratic questions for a college class to discuss this paper:

1. How might acknowledging and discussing uncertainty in psychological practice impact client trust and therapeutic outcomes?
2. In what ways could embracing uncertainty lead to professional growth for psychologists? Are there potential drawbacks to this approach?
3. How might cultural factors influence the experience and management of uncertainty in psychological practice?
4. What ethical considerations arise when psychologists disclose their uncertainties to clients? How might this impact the therapeutic relationship?
5. How can training programs strike a balance between instilling confidence in new psychologists and preparing them for the inherent uncertainties of practice?
6. In what ways might the experience of uncertainty differ across various specialties within psychology (e.g., clinical, organizational, counseling)?
7. How might the increasing use of technology in psychological practice (e.g., teletherapy, AI-assisted tools) affect psychologists’ experiences of uncertainty?
8. What role might professional organizations play in supporting psychologists’ management of uncertainty throughout their careers?
9. How might the findings of this study apply to other helping professions, such as social work or counseling?
10. What potential benefits and drawbacks are there to working in a niche area as a strategy for managing uncertainty?