After finishing a 50-minute counselling session, Natalie Cawley was sprawled on a hospital bed hyperventilating into a paper bag in an attempt to regain some sort of mental equilibrium. The rising and falling of the inflating paper before her eyes helped her to visualise her panic; with every breath she felt her anxiety reducing. The man she thought she was going to marry had dumped her by text, and she was struggling to cope with everyday life.
But Cawley wasn’t the patient. She was the medical professional helping some of society’s most vulnerable navigate their own emotions. Her new memoir, Just Coping, details her tumultuous first year as an NHS trainee psychologist where she was stuffed into a small cupboard-sized room fit with two chairs and a table, and handed up to seven clients per day who suffered from issues like extreme self-harm, OCD and borderline personality disorder.
It was a stressful start to her career to say the least, not taking into account her own heartbreak following the end of a relationship. The daily four-hour London commute took its toll; she sustained on Diet Cokes in between sessions, and struggled with sleep paralysis. “It was trying to put one foot in front of the other,” she tells i. “The adrenaline was keeping me going. It was like I was running on fumes. The sleep paralysis was terrifying. I guess I was just exhausted from the emotional content of the day.”
Although she’d undergone a high level of training and studied psychology through A-Levels and university, Cawley says you can never prepare for the human responses and emotional baggage that comes with helping people with mental health problems for hours on end each day. On her first day of counselling, she was filling out CBT worksheets, awaiting the arrival of her adolescent and young patients on the ward, expecting some straightforward cases.
She quickly realised that you can never prepare for what comes through the door. “They try to really skill you up and give you tools but I suppose on a human level, you never really have a tool for somebody coming in and saying they’ve poured petrol on their arm and set it alight.”
When a young patient came in explaining they’d scratched their arms and she asked to see, she was met with skin grafts and severe injuries. Others she’s treated, typically over six sessions in the NHS, include diabetics struggling with the mental impact of losing a limb, and young cancer patients.
Her personal life was no better. She dated an alcoholic and cocaine user, an emotionally abusive narcissist, and a pathological liar. She was staying up at night, eating ice cream for dinner due to her empty fridge, and doubting her own abilities as a psychologist. Her own therapist once told her that although her patient work was strong she only seemed to be “hobbling along, getting by”.
It’s not uncommon among medical professionals. One of Cawley’s closest friends (a clinical psychologist) was left traumatised after a young person passed away on her ward during the pandemic. Her supervising psychologist took her own life, and many others she comes across have had serious reconsiderations of their careers. “The professionals involved are probably deeply emotionally shaken and times can be really difficult for people in the role,” she says. “They talk about us being wounded healers, and sometimes it’s a coping mechanism to learn to treat something that you yourself are struggling with. You feel like you can then gain some control over it in some way,” she says.
It’s something that has stuck with her from her university days. When a professor asked her why she was undertaking psychology and she responded with a “wishy-washy” answer, he told her: “I think you’re seeking control because you emotionally feel chaotic.” Now, over a decade later, she says he was right.
Still, she believes her own experiences, and being a self-confessed “very emotional person”, have led her closer to her own patients, and able to relate to them more. Cawley feels mostly connected to patients with borderline personality disorders. “I seem to take them home with me more than others,” she explains. “I think it’s because of how deeply they feel things and how dysregulated, erratic and impulsive they can be so trying to mitigate for them and predict and plan things can really keep you on your toes. You have to be so attuned and aware.
“It can be quite draining if you know you’re trying to do that all the time,” she admits. Over her 13-year career across NHS and private wards, Cawley has become better at switching off at home, and not carrying the emotions of patients out of the hospital. She always spends some time after the work day writing down a few themes that she’s seen and key information from the day, and then attempts to do something for herself. “I’m a big lover of comedy. I find that escapism is good. I can totally shift my state, and then other things like pilates and walking can be good especially if I’ve been sitting at a desk all day and feeling trapped.”
Around her friends, Cawley adopts a different persona that’s more distant and “colder”. She uses humour to help them and often gives them insights and advice, but not in the same way as she would a client.
In the industry, Cawley has to take each day as it comes. Sometimes she’s in clinic rooms with no windows, other times in small converted spaces which double as doctor’s rooms, which she says neither of which are therapeutic or welcoming for clients who are coming in to express their emotions.
The shortage of rooms in the NHS is to blame, but it’s not the only problem. “There’s a lot going on in the system right now that’s very problematic. There’s a lot of access issues; there’s a lot of shortages. There’s huge waiting times and trying to get an ADHD assessment is near enough impossible.” Some of her colleagues have seen anger directed at them for the state of the NHS, but she’s been “lucky” and avoided this.
When she does feel low she has her own therapist and has had sessions on and off with multiple professionals, including Kelli, since university. As a trainee psychologist, it’s compulsory to attend the sessions and while doing her degree she would sit on a green velvet chaise longue for sessions. Many mental health professionals seek their own therapy out, she says, and even now she attends sessions twice a month, or is the therapist for others in the same boat.
What she’s seeing most at the moment is young people with addiction issues, typically ketamine or numbing substances. That, or loneliness and break-ups, are what she is seeing weekly. One man, Bill, had major avoidance issues and despite her advice, was struggling to end his relationship. Eventually, he told his girlfriend that he was going blind and couldn’t see her anymore.
Cawley feels most frustrated at times like this when her advice to help patients work through certain issues is ignored. “People feel stuck and it’s about working through that. You just have to be curious about their resistance and what the illness is doing to them,” she says.
“I am always very proud of people when I do see change or see them building up resilience or theory tool boxes. It’s a nice feeling.”
Cawley has received many thank-you cards and words of appreciation from patients, which can make all the difference to her days. She feels lucky that there are some clients she’s worked with for multiple years, and grown with them as people, and witnessed their progress. “You really get to know them on a deeper level, and the door is always open. If they go off or they’re doing better, they can still always come back. It’s very supportive and open.”
For trainee psychologists her advice is to accept that worrying is part of the parcel. “Everyone in my experience so far has had some element of imposter syndrome and it’s tied to them being empathetic and caring people. If anyone is struggling with that, I think know that it comes as part of the role. Just be accepting and not worry as we all have it.”
Just About Coping by Natalie Cawley is out now (Pan Macmillan, £16.99)