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
Key Points
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.
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 usingnarrative 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.”
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.”
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.”
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…”
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.”
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:
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’.”
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.”
“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.”
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.'”
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.”
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
Limitations
Clinical Implications
The findings have several important implications for psychological practice and education:
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.
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Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
