A sense of dread washed over me, and my stomach churned as the incoming call on a Saturday afternoon was from my training director at my practicum site. I did not have to answer the phone to know what she was going to say: the clinic was closed until further notice due to COVID-19.

As I graciously expressed my understanding of the termination of my in-person practicum training experience, I internally panicked. Despite the loss of clinical hours, I felt hopeful because I had a second practicum in which I could continue to collect assessment hours.

Monday morning, I promptly contacted my other supervisor to inform her of the situation. She kindly offered me additional hours, but my momentary relief quickly dissipated as patients failed to show to their appointments. A week later, I received notification from my school instructing students not to attend in-person practicum training.

As a third-year doctoral student, the inability to attend practicum and accrue hours was devasting. I had moved two hours away to participate in two neuropsychology practicums to be competitive for the Association of Psychology Postdoctoral and Internship Center (APPIC) match this fall.

I worked vigorously this past year attending classes, practicums, and working on my dissertation to achieve my professional aspirations. It literally took a pandemic to stop me in my tracks.

The following weeks were wrought with sadness, confusion, and uncertainty about my competitiveness for the match, and the impact of practicum closures on my future career. However, I recently recognized my feelings as symptoms of ambiguous loss, which has allowed me to adjust my mindset and prepare for the match this fall. Allow me to elaborate. 

Introducing Ambiguous Loss

Ambiguous loss is defined as “a situation of unclear loss that remains unverified and thus without resolution” [1]. Ambiguous loss is one of the most stressful types of loss because there is often a lack of understanding of its impact [1].

The world is currently experiencing many ambiguous losses, including the loss of safety, social connections, personal freedoms, and financial security, and no one can predict the long-term implications of these losses on individuals and society [2].

For those of us working towards our terminal degree in psychology, the pandemic has resulted in the loss of critical learning experiences essential to our success as psychologists. For those students who are applying to the match this fall, the loss of training opportunities and direct treatment and assessment hours is particularly discouraging.

The theory of ambiguous loss has several assumptions that elucidate how to manage this challenging phenomenological experience and move forward despite uncertainty. Here are four that are particularly relevant.

Premise 1: The Source of Pathology Is Rooted in the Type of Loss and Not in the Grief Itself. Simply stated, the source of sadness is directly related to the ambiguous loss [1]. Students who are preparing for the match cannot predict how the loss of training opportunities will affect our internship applications, our ability to match, as well as the length we will remain in our programs as a direct result of the pandemic.

Premise 2: One Cannot Cope Until the Stressor Is Named. Identifiable stressors for students preparing for the match include the loss of direct clinical hours, fear of not matching, concern over having to complete an additional year of training, and the associated financial and personal implications of possible delays in graduation. Although naming these stressors may be feel overwhelming, it allows us to recognize the reasons for our feelings and begin coping.

 Premise 3: Ambiguous Loss Increases One’s Tolerance for Ambiguity. Before the pandemic, our future was considerably more certain, as we had calculated our anticipated hours and we were approaching the apex of our training. Now, we do not know what the impact of decreased training will have on obtaining a match and pursuing our desired careers. However, we must tolerate this uncertainty because we do not have another choice.

Premise 4: The Method of Adjusting to Ambiguity Is to Live Well. Ambiguous loss theory postulates that the primary way people adjust to loss is by living to the best of a person’s abilities, which is the manifestation of resilience.

More About Resilience

Resilience is a dynamic process where individuals positively adapt despite significant challenges. Boss [1] highlights processes that promote resilience, several of which are particularly applicable to students approaching the match this fall.

First, it is important to normalize your feelings given these extraordinary circumstances [3]. Students across the United States have lost significant clinical hours and training opportunities. Every student is worried about the impact of COVID-19 on their education and ability to progress in their program. You are not alone, and it is more than reasonable to be experiencing these emotions during this time.

Second, it is essential to increase tolerance for the unknown because no one knows yet the impact of practicum closures until students apply for the match this fall. Tolerance for ambiguity can be increased by recognizing the situation is unfair, and it is no one’s fault. Mastering the internal self through mindfulness practice, exercise, or other activities, can also aid in increasing tolerance for ambiguity [3].

Third, it is critical to discover new hope, which may consist of laughing at the absurdity of this situation or finding something you can control [3].

Control What You Can

A study was conducted on the predictors of match outcomes, and the findings demonstrate that the number of direct client contact hours is not the only consideration in successful matches [4]. So, if you want to improve your AAPI in ways you can control, here are five suggestions for how to advance your competitiveness while you are sheltering in place.

1. Take Advantage of Online Trainings. COVID-19 is going to change the way we practice psychology forever. Take advantage of the multiple online training courses offered through the American Psychological Association (APA). The APA is currently providing free resources and training on the provision of telepsychology, which is an excellent addition to your curriculum vitae.

2. Network With Professionals on the Internet. Nearly every university and many training programs have switched over to online formats, and various APA divisions are offering free didactic seminars and trainings. These are great opportunities to network with professionals, training directions, and students across the United States.

3. Work on Your Dissertation. An attractive predoctoral intern has completed a proposal and is far advanced in the dissertation process. Take advantage of any downtime if you are looking to knock out a chapter or two.

4. Consider Your Internship Essays. Students often put off writing their essays until the last minute. Take some time to reflect on how you want to present yourself and write a few thoughts down.

5. Enhance Your Multidimensionality. Are there activities you have wanted to do but couldn’t because your schedule was too full, such as learning a new language or playing a musical instrument? While it is equally important to not increase stress levels during a really tough time, it may be enjoyable to engage in a new activity.

Now is the time to take advantage of such opportunities for enjoyment and the development of multidimensionality, which is an attractive characteristic to internship training directors.

These suggestions do not replace the hours and experiences you have lost, and they are not preconditions for a successful APPIC application. They are opportunities to augment your personal and professional development during a period of life saturated with ambiguous loss.

However, resilience lives with grief [5], and this period is a forced opportunity to grow by tolerating the unknown, better understanding our patients, and further developing the mindset and skills needed to be successful professional psychologists.

References

[1] Boss, P. (2016). The context and process of theory development: The story of ambiguous loss. Journal of Family Theory & Review, 8, 269-286. http://dx.doi.org/10.1111/jftr.12152

[2] Weir, K. (2020). Grief and COVID-19: Mourning our bygone lives. American Psychological Association. Retrieved from https://www.apa.org/news/apa/2020/04/grief-covid-19

[3] Masten, A. S. (2016). Resilience n the context of ambiguous loss: A commentary. Journal of Family Theory & Review, 8, 287-293. http://dx.doi.org/10.1111/jftr.12154

[4] Callahan, J. L., Hogan, L., Klonoff, E., & Collins, F. (2014). Predicting match outcomes: Science, practice, and personality. Training and Education in Professional Psychology, 8, 68-82. http://dx.doi.org/10.1037/tep0000030

[5] Obama, M. (2018). Becoming. New York, NY: Crown.

Jennifer Nosker, MA, LCSW
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