Lifestyle, Psychology

Sarah Blackshaw on the Differences Between Working in Physical and Mental Health in Clinical Psychology

Many of you keen aspiring psychologists have been asking about Health Psychology and how it differs to the Clinical Psychology setting. When Sarah approached me to guest blog, I thought it was the perfect opportunity to share the knowledge with you to determine how you can work in health settings as a Clinical Psychologist, a setting many aspiring psychologists often overlook.

Sarah’s blog is very informative and I love how it also brings a new angle to clinical psychology. I hope you enjoy!


Hi all, thanks for reading this guest post. I wanted to start by saying a bit about me, then I’ll get right to the good stuff, I promise!

My name is Sarah Blackshaw, and I’m a clinical psychologist. I qualified a while ago now from the University of Hull – their clinical psychology doctorate is fairly unique, as you don’t go through clearing. Instead, you get “fast-tracked” from undergraduate, via a year of work experience, onto a doctoral course. Since then, I’ve worked in many different areas of physical health such as cancer, diabetes and HIV, but I’ve spent the majority of my career working in the field of chronic pain.

I love working in physical health! For me, it takes the best parts of my training in mental health and applies them to a really novel context. I get to help people learn to live well with a condition that, at its worst, threatens to take life as they know it away from them, and that can be really rewarding. I love it when people come back and tell me that they’ve started painting again, or riding their bike, or that they’ve gone back to volunteering. Those are the things that make up a life, and they’re so important in managing any condition – physical or mental.

First, I think it’s important to mention that clinical psychology and health psychology are different disciplines. Health psychology tends to concern itself with studying behavioural processes in health-related areas – so, for example, researching why people smoke to produce a model taking into account psychological and behavioural factors. With that model, a health psychologist might then develop a health promotion strategy to help people to stop smoking. Clinical psychology within physical health is more about using psychological models to manage the knock-on effects of health conditions, such as anxiety or depression, and considering the barriers to implementing healthcare advice. Of course, there is a lot of overlap between the two – I’m not saying that health psychologists don’t work with mental health problems sometimes, where they apply to health promotion – but this is one of the general differences.

When most people apply to become clinical psychologists, they think of working in mental health services and helping people with diagnoses such as depression, anxiety, bipolar disorder or personality disorders – I know that’s what I thought I would be doing! But the more I learned about physical health, the more interested I became in working within that area. This blog post is a bit of a generalisation, as it is difficult to think of areas of physical and mental health that are completely different – there’s a lot of overlap, particularly with mental health conditions that are more longstanding – but generally speaking, these are some of the things that I think are different when working in physical health:

It’s more about adjustment than overcoming

If you’re working with conditions like depression and anxiety, you might be working with someone to “overcome” that condition (that is, make it so that it is either completely gone or, more likely, almost unnoticeable). With things like diabetes, HIV and chronic pain, that’s really not possible – you are likely to always have that condition and it will always have some sort of impact on your life. Clinical psychologists can help people to manage the impact of that condition, so that people can still do the things they want to do, within reason. In my role working in chronic pain, I’ve helped people to do normal, everyday things like going to work, riding a bike, visiting family – in spite of the pain. Some people can feel a bit disheartened when working with a condition where there is no hope of “recovery” in the traditional sense, but I love it because you really get to understand what is important to people and help to make a difference to their lives.

You could be working with a condition that is fatal

Now let’s not be naïve – conditions such as depression can absolutely be fatal in that they can lead people to harm themselves and die by suicide, but here I’m talking about conditions that are fatal in and of themselves, like cancer and sometimes HIV. Working with people who are in the palliative and late stages of illness means confronting the big, scary stuff – what is going to happen to their cat when they die? What would they like their funeral to be like? How can you help them to manage any anxiety or other emotions that they might be feeling? It’s a privilege to work with people when they are close to dying, and I will never forget the people who have died whilst I’ve been working with them.

You might see some medical stuff

There’s no way around this – if you’re working in a hospital, you might see some stuff. I’ve observed surgeries, had patients show me various bits of their bodies without giving me chance to object and, on a couple of memorable occasions, their infected surgical scars. It can be…a bit gross. But it’s only a small part of the job in the grand scheme of things, and can be really helpful to understand how that person is feeling and why they’re struggling so much. Nothing helped me more in part of my job than seeing the surgery that I was assessing people for – now I understand the whole procedure, how people might feel when they’re waiting for the treatment, and what is going to happen when they come in to hospital, and I can tell people my understanding based on experience rather than explaining what I’ve read.

You learn a lot about how to explain physical concepts as well as mental ones

Clinical psychologists learn a lot about things like anxiety, and how they impact on the body. When you’re working in physical health, you’re also working with people to help them understand how those physical processes can impact on their health condition. For example, anxiety activates the ‘fight or flight’ system in the body, and that can cause a lot of different physical responses such as increased heart rate, sweating, increased muscle tension and shallow breathing. In people with chronic pain, this can make pain worse, and pain itself can activate the same ‘fight or flight’ system as pain is designed to be stressful! Explaining this clearly to people and helping them to understand what’s going on in their body can also help them to have faith that you’re not saying their health condition is “all in their head,” which is a common concern for people with issues such as pain and fatigue.

Overall, I feel very lucky to work in such an interesting area, in the intersection between physical and mental health. I hope this post has helped you to think about whether it’s an area you might like to work in too!


Thank you so much Sarah for sharing your insight on working in Physical Health settings as a clinical psychologist. Let us know in the comments if this is something that you’re pursuing, we would love to hear from you!

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