I specialise in child and adolescent mental health for the East London NHS Foundation Trust. We work with children and their families – young people can be referred to us by their school or GP. In our service, we don't see many very young children; mostly they are seven or older. They come for a variety of reasons, but depression and anxiety are common, as well as behavioural problems and anger.
On Mondays I supervise a trainee clinical psychologist. We talk about her clients and I try to advise her on approaches to try. Then I would see a client for about 50 minutes. One part of my job is doing assessments of new clients. This week I met a teenage girl who is depressed and possibly hearing voices. I ask questions, about her early history and family – if there have been any stresses, deaths or separations. I would try to find out when it is worse or better and check how she functions with her parents, how she is sleeping and how she makes sense of it all. Around once a month I am on the rota to assess people under 18 who have deliberately hurt themselves and have been taken to hospital.
I will see about two or three clients in a morning or afternoon and it can be exhausting – you have to work hard to put yourself in their position. Often by the time a child or teenager gets to us they have had difficult experiences with adults, so you have to work harder to engage them. You need to make them feel validated or they won't come back. It takes a lot of energy and does affect you.
On Tuesday and Wednesday I ran a workshop with colleagues for around 25 parents whose children have been diagnosed with autism. Parents often have guilt or anxiety about what has caused it and we have to tell them it's not their fault. We talk about what can be helpful and bring them together to talk.
On Tuesday evenings I have a clinic until about 8.30pm. I see around three children and their families. One was a 17-year-old girl who is anxious and has had some really difficult experiences in her life. Eventually I will work on looking at her beliefs around her constant worrying. I imagine she thinks worrying keeps her safe. So we might experiment with her trying just worrying for half an hour in the evening and not all day. There's no set routine on a Thursday; I might have to go to a meeting in a school to give some feedback to teachers or meet social services. This week I had a home visit with a family. They have a teenage daughter with Asperger's Syndrome and additional mental health problems. On Fridays, at the moment, I do additional training in cognitive behavioural therapy.
Some days when children have multiple problems, such as living in poverty and adversity, it can be hard to feel you have made a difference in their lives, but you have to remind yourself that change can come through small steps. The best thing is when a child doesn't need you any more.
• As told to Homa Khaleeli
