3.2 Becoming a critical health psychology practitioner: Practicum, internships, placements, oh my!

Overview

In this chapter, I discuss the value of practice placements (practicums) and how they might differ for the critical health psychology practitioner. I will discuss application-based learning beyond the traditional psychological focus on the individual, with a strong emphasis on being theory informed and centring social justice. This lens will be applied not only to the ways that critical health psychology practitioners might work and who they work with, but also to how they might “become” through application-based learning within an assemblage of supervisors, skill acquisition tasks, placement locations, and university systems. This chapter is explicitly written for those who are participating in a process of learning with such a practice-based component. As such, approach it questioning how you might think about the processes involved in becoming a critical health psychology practitioner through the lens of critical theory.

 

Introduction

Much of what you have been exposed to in this textbook so far are examples of theory, the way theories can manifest in research, and the kinds of things critical health psychology practitioners might be interested in. You have also been introduced to examples of work by researchers and practitioners, who are well-situated within the practice and research space. The readings in the textbook can then act as guides or sources of knowledge about what is possible within critical health psychology and what others have done before you. They are there to help draw you into being part of a new generation of critical health psychology practitioners, engaging in work that continues to challenge inequities through system-levels advocacy and change, enabling better health outcomes for people by focusing on broader social forces, rather than being limited to people’s individual choices and behaviours (Chamberlain & Murray, 2017).

In Chapter 3.1, you have also been given some direction in terms of the kinds of knowledge you need when moving from a theoretical understanding of critical health psychology to being a practicing psychologist—especially in Aotearoa New Zealand. That chapter focused on the necessary tasks to become a practitioner. As Fraser and Walker note, ethics and reflexivity are central to practice, and those are defined by the cultural environment where you want to work. In the case of Aotearoa New Zealand, the centrality of Te Tiriti o Waitangi is emphasised, because of its role (including breaches across decades) in shaping the cultural and material conditions of people in this country. This chapter takes a slightly different path, exploring the ways that you can take the knowledge you have gained from being a student (alongside theoretical material from other parts of this book) into the realm of application-based learning—the liminal space between study and practice.

To further understand this pathway, the chapter starts with an introduction to some of the theory and history of application-based learning within psychology. I will then turn to the ways that critical health psychology practice might be conceptualised differently from mainstream forms of practice—in particular, critical health psychology’s focus on the pou discussed in full in the textbook introduction:

• valuing theoretical and conceptual thinking.
• challenging taken-for-granted understandings.
• paying attention to issues of power and equity.
• moving beyond the individualism that characterises much of (Western) psychology.
• considering knowledge as produced in social context.

It is worth noting here that many of the procedures of application-based learning in psychology, whether mainstream or critical, might look the same. However, the theoretical content and focus of critical work can sometimes run counter to the expectations of various mainstream systems, which may be primarily interested in training workers in a defined subset of skills or competencies. It is important for those wanting to become practitioners of any kind, but who are still interested in remaining answerable to critical concerns, to take these differences into account. This is necessary to managing a set of tensions they may not have expected to encounter in moving from theory to practice. To help frame this conversation, I will draw on the theoretical constructs of liminality, assemblages, and becoming to highlight the value of disruption and instability to the development of a critical health psychology practitioner. I will argue that reflexive engagement with discomfort is a key strategy in the process of transitioning from student to practitioner. Before moving to the next section, it is worthwhile engaging with Exercise 1 to begin your process of reflexive engagement with the ideas in this chapter.

 

Application-based learning and the practicum

Application-based (or practice orientated) learning is different from most tertiary study the average postgraduate student has experienced. There is a significant jump from reading about something to doing something, especially in workforce roles that are dedicated to the kinds of things critical health psychology practitioners are interested in. This is both exciting and intimidating! You may have experienced discrete moments of application-based learning in your study to this point, associated with course assignments or other course-based activities. However, in postgraduate study and moving toward employment in psychology and psychology-adjacent roles, application-based learning can become a key ingredient in helping you move toward “workplace readiness” (whatever this means to you).

The recognition that becoming a practitioner involves exposure to and repetition of practices, skills, and development of particular competencies has resulted in an orientation to bringing students through an intermediate stage of development—practical application of knowledge (Callahan & Watkins, 2018; Cooke, 2018; Nicholson Perry et al., 2017). For some, this might be limited to research as they work through a research “apprenticeship”’ doing an Honours, Masters, or doctoral level project. For others, professional pathways (clinical psychology, clinical health psychology, counselling psychology. etc.) might be formalised in a programme. Textbox 1 outlines some of the possible application-based learning opportunities you may be exposed to in a university postgraduate setting.

 

 

Development in application-based learning is typically generated through a) practices and skills that reinforce some of the theoretical or even hypothetical knowledge developed prior, and b) making reflective change to practice in ways that enhance competence and help produce identity (Callahan & Watkins, 2018). For the practice of applied forms of psychology this makes perfect sense, as people need skills-based learning to embed and develop knowledge gained from reading and completing assignments. In these cases, programmes explicitly orientate to training professional psychologists, navigating tensions between scopes of practice outlined by the discipline’s organising body (in Aotearoa New Zealand, the NZ Psychological Society), educational requirements of the university and government (in Aotearoa New Zealand, the Ministry of Education via the Tertiary Education Commission), and the skills and knowledge required by the sector a given role is located in (e.g., the health sector). The ultimate purpose of application-based leaning in these instances is to take someone from beginner level knowledge of practice to a particular expression of expertise (Nicholson Perry et al., 2017; Skovholt, 2012)—assuming everything goes well!

Within mainstream psychology, particularly the clinical subdisciplines, application-based learning has a long history (Palitsky et al., 2022) and is now extremely common in professional subdisciplines of psychology (Callahan & Watkins, 2018; Carless & Taylor, 2006; Mpofu, 2016; Palitsky et al., 2022). Core to this are the needs of a healthcare workforce, ensuring particular roles are filled to meet (increasing) demand for psychological services. Prior to the 1990s, much “real world” training in psychology was done after the movement into the workforce, through in-service based on the job training (Cooke, 2018; Mpofu, 2016). However, for various reasons, this is something that now falls within the domain of higher education programmes, where universities manage the shift from theory to application within the context of a wider programme (Mpofu, 2016). In these contexts, placements “host” students for short periods of time allowing them to practice under supervision. Consequently, much of the value of these experiences relies on good quality training, placements that expose the practitioner to “real world” practice, and developing the competencies of the student to make them workforce ready (Callahan & Watkins, 2018; Kaslow, 2004).

In the Aotearoa New Zealand context, professional doctorates and other formal programmes containing practical experience have been the norm since the 2000s (Mpofu, 2016), with various tiers of practitioner being established, including the recent development of an assistant psychologist category (Shearer & Chadwick, 2024). These programmes are often designed to create professional identity and train autonomous practitioners with a clear scope of practice within a desirable set of competencies. Often these programmes define good training as orienting to “evidence based” or “empirically validated” therapies with an explicitly individualised orientation. They are therefore answerable to concerns of consistency—producing a certain kind of practitioner within a constrained period of time that will enable the workforce to be bolstered and replenished. The application-based learning components within these programmes (often in different locations) are designed to meet the expectation of a certain number of hours of supervised practice – in Aotearoa New Zealand, this is set at 1500 hours (New Zealand Psychologists Board, 2023). This period of time has been determined as sufficient for a practitioner to develop the needed competencies of the role.

For those of us wanting to extend our understanding of critical psychology into our practice, the process is likely to be different to this programmatic approach. As Fraser and Walker note in Chapter 3.1, there are many places a critical health psychology practitioner might end up working. Further, while a practitioner might be informed by critical theory, many features of the programmes they engage in might be entirely “mainstream” (including the kinds of work they end up in). Consequently, one of the key ingredients to success in application-based learning for a critically oriented practitioner is a willingness to engage with the tensions between their programme of study, their desired working environment, and the theory and values one has gained through engagement with critical psychology theory. These elements are not always congruent with the articulated values of a profession or work environment, and so “fit” might not always be obvious. Textbox 2 describes a broad typology of different kinds of environments you might be expected to participate in a practicum. Some of these involve more adaptation than others, either being more mainstream than you might want or more critical than the environment is able to facilitate.

 

 

Irrespective of the practicum (or programme) type, the movement towards becoming a practitioner is one where transition and tension are commonplace. Given that placement locations may or may not be familiar with critical theory, or invested in approaches that emphasise notions of equity, power, systems orientations, etc., a practicum then becomes an opportunity to explore how these ideas might work (or not!) in a given workplace environment. There is no question that this is also unsettling for many students as they seek to develop new skills and apply material they have been absorbing in their courses. For the student, questions of who they are, what they might become, and what is needed to support this “becoming” become essential to development. These characteristics are markers of what the literature describes as a “liminal occasion” (Greco & Stenner, 2017). Reflexively engaging with this theory and its importance for reflexivity (see Fraser and Walker, Chapter 3.1) are the focus of the next section.

Practicum as a liminal occasion

Within the context of a practicum, it is worth adding to the reflections from Exercise 1 that you are likely not (yet) a critical health psychology practitioner. Rather you are in an in-between state, somewhere between “student” and “professional” (Callahan & Watkins, 2018; Mele & Marsico, 2019), with all the possible subject positions available within and between these two categories. Some people may have already been in the workforce for some years before taking up postgraduate study, while others may have moved, from school to study, with limited experience of the workforce. Irrespective of the pathway taken, the movement from education to work can be understood as one associated with liminality:

These kinds of liminal zones are often marked by a sense of vulnerability, anxiety, and a lack of confidence in abilities (Mele & Marsico, 2019). In other words, if you are feeling those things coming into your practicum, that’s not unusual!

It is also worth noting that while periods of transition can feel more intense than others, liminality is a defining feature of human experience —it is normative. We are always moving through change, even in our day to day lives, and this means we change and become something different in different contexts—people are always in process (Turner et al., 1969). You will have experienced this in various ways already. For instance, our home spaces demand different ways of being and acting to other spaces (such as work or school) and we transition into something different and even “become” someone different when we move between them. Some transitions are considered socially important, like childhood to adulthood, or moving from being otherwise healthy to experiencing a chronic health condition.

Greco and Stenner contrast this with the liminal hotspot—where there is risk of getting “stuck” between two mutually exclusive alternatives. To illustrate the differences between valuable and problematic outcomes from liminality, Greco and Stenner (2017) use the mundane example of responding to a phone call from a parent in the midst of hosting a social event. Using a phone has the potential to take us “elsewher”’, so we cannot be fully present with our friends who are physically in the room with us. Nor can we fully attend to the conversation on the phone. These moments have the potential to “transform” us, perhaps through us apologising and moving into another room and becoming deeply connected to the person on the phone. They can also involve us shifting our identities, from host and friend to being a dutiful child attending to a parent on the phone. However, if we stay in the room, and try and engage with our parent while staying within the social event, we remain trapped in the in-betweenness, offering limited value to ourselves or either possibility.

The in-between space of becoming a practitioner, yet still (and always) a student, might also be seen as a liminal occasion. Some mainstream responses to this occasion might seek to manage its uncertainty and complexity through focusing on “training”—where you gain a set of workplace skills and competencies from a trainer experienced in those skills. These skills and competencies can then be tested as a way of validating the movement from student-who-needs-supervision to practitioner (Kaslow, 2004). This sort of training process is seen to (positively) constrain the number of pathways available (through skill specialisation) and reduce the risks of “rupture”, “uncertainty”, and “delayed entry”. In this way, liminality is managed but very much treated as a problem. It is a problem that can be mitigated through a “rite of passage”—such as training and then registration as a psychologist. Many students seek to resist the intensities of liminality, and can become invested in a particular kind of work as an outcome of their study, hence the strong appeal of professional programmes that help develop a sense of professional identity and practice (Mpofu, 2016). However, this kind of approach, while “safe”, might miss opportunities to engage with tensions that stimulate growth and depth as a practitioner. It might also involve missing out on critical understandings of people and health (Part 1 of this textbook). It also might mean ending up persisting with simplistic approaches to diagnosis and treatment (challenged in Part 2 of this textbook) and not embracing complexity and people-in-their-contexts.

While engaging with a mainstream programme can be a strategy to mitigate the uncertainties of liminality, it does not always allow students who have taken up some critical theory, including its ethical orientations and values, to integrate these ideas into practice. There are certainly ways to be and become critical as professional psychologists, and many of the recommendations that Fraser and Walker (Chapter 3.1) offer will support this—especially with reference to notions of reflexivity and cultural safety. However, this approach risks always being subsumed by the expectations of professionalism, as a practitioner’s answerability to scopes of practice and the systems that they work within dominate their practice. In this way “being critical” can risk becoming tokenistic, without consistent reflexive practice and a willingness to understand and resist individualistic and pathologising practices.

Another approach to mitigate the “risks” of liminality is by engaging in a programme that supports critical theory. A partially critical or fully critical programme (see Textbox 3) might enable you to work with theory but also gain some of the experience of working in a placement that gives you confidence about your readiness for the workplace. For instance, the programme at Canterbury Christ Church described in Textbox 2 would allow you to “fit” within a health sector role, where there is high demand for practitioners with mainstream skills, while keeping open to social justice orientations and critical theory (Cooke, 2018). These kinds of programmes exist in a wide number of contexts, due to increasing demand for social justice informed theory and practice (see, for instance, Hage et al., 2020).

You might also see the value of a programme such as the one at Massey University, which offers a best of both worlds approach (see Textbox 3). Such programmes are designed around critically informed courses, including a practicum element that supports critical reflection and broad, health orientated placements that expose students to a greater range of possibilities than offered in mainstream programmes. As such, they provide some of the sense of liminality mitigation that other formal programmes provide, while also scaffolding the student with a supportive practicum experience, that emphasises critically informed practices and supervisors.

 

Embracing uncertainty and the in-between

All pathways involve a liminal occasion in the in-between space of becoming a practitioner, and thus some risk and uncertainty. Mitigation pathways, such as the features of a particular programme, might reduce some of the uncertainty in the liminal occasion of a practicum and are understandable as a choice. However, relying on a programme to do all of the mitigation of uncertainty as a strategy may end up limiting some of the benefits of embracing liminality and the opportunities it produces for all involved. Students who are supported to embrace various uncertainties and adapt to their work environments can bring important skills and resources to practice (Mele & Marsico, 2019), as well as a different kind of growth as a developing practitioner. Further, there is increasing evidence that the values that inform practitioners’ work can be as important, and sometimes more important than the skillsets many mainstream programmes train people in (Callahan & Watkins, 2018; Cooke, 2018; Skovholt, 2012; Terry & Kayes, 2019; Toporek & Vaughn, 2010). Certainly, students and new practitioners working in psychology and other practice-based roles continue to emphasise the importance of critical theory (especially social justice informed frameworks) to their development, and to inform their practice (Callahan & Watkins, 2018; Cooke, 2018; Hoover, 2016; Lewis, 2010).

Mechanisms that support a pathway through the liminal occasion of a practicum can bolster particular values and knowledge, enabling a depth of practice and effecting change for both the developing practitioner and even the placement environment. At a minimum, exposing yourself to the liminality of “becoming-a-practitioner” and understanding its impacts, can give insight into the kinds of difficulties people can experience in relation to health and ill health. Reflecting on how uncomfortable you might feel in a given liminal occasion (no matter how small) may support your empathy for those dealing with complexity and disruption, including restrictions and limitations on access to support and culturally safe environments (e.g., Curtis et al., 2019; Terry et al., in press). To further extend this, there is a risk that ideas of social justice and critical orientations might become superficially layered onto otherwise mainstream skills, practices, and ethics in unhelpful ways. Good examples of how to resist this superficiality have already been raised regarding Te Tiriti o Waitangi in Chapter 3.1, appreciation of Hauora Māori in Chapter 1.1, and engaging with disability and disabled people in Chapter 3.4. In all of these cases reflexivity is an important tool to manage the multiple liminal occasions found within practice (e.g., offering cross cultural care).

Reflexivity is not just a navel gazing exercise, but rather a process of reflecting deeply on the environment you are in. You should ask yourself the following questions:

• how are you being changed by it?
• how are you changing it?
• is there any observable change or are you simply going through the motions in your practicum, concerned only with “passing” (whatever that entails)?

Tools like reflexivity should be central to the practices of a critical health psychology practitioner, irrespective of the work or placement environment. Whatever transition you are making—through a formal programme, through a practicum experience, or even through a shift from study to the workplace without a formal scaffolding, reflexivity can help make sense of the vulnerability you experience and complexity of the transition in important ways. Beginning early with reflexive practices (such as the one advocated for in Exercise 2), and continuing to reflect on and integrate new learning, will expedite growth in your capacities and potential. Reflexivity can provide you with creative solutions to problems and thoughtful integration of theory with practice. It can also mean you are always willing to understand what you can contribute through advocacy and allyship, as well as in the kinds of care you offer through your practice.

 

While much of this section has focused on your own navigation of a liminal occasion, this does not mean you are becoming a practitioner in isolation. You do not “become” solely in relation to your own limited resources and capabilities, and your reflexivity does not simply apply to your own inner thoughts. Rather you-as-becoming-practitioner are produced through the intra-action of various human and non-human actors. You are one element in a symbiosis of moving parts, with different demands, needs, expectations, practices, resources, and thinking contributing to your development. In the next section, I will lightly reintroduce some of the theory of assemblages and becoming from earlier in this textbook, to think about the production of you-as-becoming-critical-health-psychology-practitioner.

Practicum as an assemblage

There are a variety of theories available to make sense of the “person” or the “subject” within critical psychology. One of these is the idea of assemblage from new materialist theory, influenced by Deleuze and Guatarri’s (1987) process ontology. In contrast to our typical (and often) dominant understandings of humans as self-contained and autonomous subjects, these approaches treat “the person” and therefore “the practitioner” as radically open, not defined by static binary categorisations. The subject is considered an outcome of generative processes, where humans and their capacities are understood as continually being made and unmade across different encounters (Braidotti, 2006; Gibson et al., 2021). A simple example of an assemblage is a person’s “relationship” to their smartphone—it enables connections and presence in places they are not physically located in, which challenge the boundaries of the individual person’s skin and bones. Social media, social connection apps, people that call us during a social event, television, news, and radio all blur the boundaries between the person and their environment—and all of these interactions are as “real” as any other. Augmented reality and virtual reality technologies only add to this blurring (Al-Ansi et al., 2023).

The practicum might also be understood as a complex assemblage, where the person-who-is-becoming-a-practitioner is only one element. As discussed throughout this chapter, a practicum brings together real-world experience, theory and knowledge drawn from study, and the relationships between a student-becoming-practitioner and supervisors (there are usually more than one!). It also involves the particularities of the placement location and any colleagues you may have there, as well as a cohort of students also doing their practicum in similar kinds of environments. It might involve clients you interact with, or a population that a public health programme seeks to engage with. Human actors can play a part in shaping you-as-becoming-practitioner, but so does the placement location itself. Within assemblage theory, non-human actors contribute as much as humans in helping to produce you as a subject. In this framing, the environment (i.e., a placement) is not simply acted upon by the becoming-practitioner, but also acts to produce the practitioner in various ways. The same is true of university systems and support structures (including libraries and Learning Management Software like Moodle, Stream, or Canvas). Exercise 3 gives you the opportunity to try and map the various elements of the practicum you are participating in.

 

 

Within this framing, it is good to be reminded that you are not the only component of the practicum assemblage, but you may be the newest. So, while the assemblage might feel “new” from your particular perspective, think of the assemblage as existing before you came, changing as you come in, and producing different effects as it forms and reforms. To get the most of this experience is to embrace and learn from what exists, while acknowledging you will become part of the assemblage on your journey to becoming. As such, the “success” of the practicum is not just about you-as-practitioner, but about the assemblage as a whole. All of the elements “desire” success and work together to make that happen. This is one of the reasons why the practicum at Massey is built around pass/fail orientations (rather than a particular grade)—it reflects the assemblage working together to enable something new and valuable. After all, practicums are considered important not just for training individual practitioners! Placement opportunities would not exist, and supervisors would be uninvested in supervising if this were the case. Each element should benefit from being part of the assemblage. The better an assemblage works, the better outcomes for all of the elements involved in it—it is a symbiotic relationship (Alvesson & Sköldberg, 2018).

Practicum as becoming

One of the key features of assemblage theory is that you-as-becoming-practitioner are always becoming, never finished, nor settled, and even assemblages form and reform in the same ways. You will never “be” a practitioner outside of involvement in an assemblage (despite titles, roles, notions of “expertise”, and even pay checks); instead you are always becoming. You will leave the practicum assemblage but then join a new one, where you bring many of the elements of the previous assemblage with you. These act as resources for the new assemblage, and as you-as-practitioner continue to become something new in each instance. Elements of an assemblage may come and go, but they always leave an impact on what remains behind. The mapping exercise above can then act as a useful framework for understanding new roles, new assemblages, new kinds of work. As an example of the value of this kind of activity, I have recently heard of a senior manager who was shifting between departments in their organisation. Her reflexive practice of taking a day to map what she was taking with her, what the new environment would look like, and how it might benefit from her previous assemblage, offered immediate positive effects. Reflexivity can therefore be extended to think well beyond your own understanding, and social position to the elements that shape you continuously—even beyond the term of the practicum.

As a new component in the practicum assemblage, there is a lot to benefit from if you can embrace the liminal occasion, the uncertainty, and be highly reflexive. The benefit of going into an environment you have not experienced before is also going to result in forms of becoming that, while potentially anxiety producing, are also exciting. Managing emotions will become a significant feature of your practice. Exercise 4 gives you a set of reflexive questions to ask yourself at the end of your practicum.

 

 

Be careful about working across assemblages as a student. For instance, some students try to stay within existing work assemblages and “tack on” those of another (the university or training elements, including supervisors). However, this ends up being overly complicated, as the different expectations of each of these assemblages can clash (e.g., an existing role might require you to continue doing a certain kind of work that does not fit with the expectations of the practicum). At Massey, we recommend a practicum that is an entirely different place for this reason. Trusting in the process of becoming within a practicum assemblage, and the kinds of directions the assemblage moves toward are fundamental to its value. There is depth of experience, knowledge, and relationships that can be drawn heavily on as you move from student-who-knows to becoming-practitioner-who-applies.

Conclusion

In this chapter, I have explored the ways that various kinds of theory within critical psychology can enhance our understanding of the practicum experience for future critical health psychology practitioners. At the heart of this is a consciousness that sometimes practicums are unsettling and complicated for students who have largely only engaged with knowledge as something to absorb and then reproduce through essays, exams, and other forms of writing. Moving into the mode of knowledge application is a step on the way to workforce readiness, an intermediate step that can be used to integrate some of your learning into skills, practices, values, and knowledge. This transformation process is one marked by liminality, which can be embraced, resisted, and mitigated, but if managed well can result in positive transformation. Core to that transformation is the importance of the practicum assemblage, which de-centres the student, locating them as one element within a broader configuration of people, practices, and things—enabling the becoming as a practitioner.

 

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