Social Work Spotlight - Episode 81: Alex

Episode Date: April 14, 2023

In this episode I speak with Alex, the owner of Mindful Recovery Services, a private practice providing psychological treatment and support for adolescents and adults. Alex is passionate about dispelling myths about mental illness and is highly skilled in dialectical behavioural therapy. She is an experienced public speaker and provides consultation to other professionals on managing difficult behaviours in teens.Links to resources mentioned in this week’s episode:Alex’s business (Mindful Recovery Services) - https://www.mindfulrecovery.com.au/Mindful Recovery Services on Facebook - https://www.facebook.com/mindfulrecoveryservices/Gerda Muller, clinical psychologist and business coach - https://gerdamuller.com.au/Gerda Muller’s Facebook group (Private Practice Success) - https://www.facebook.com/PrivatePracticeSuccess/The Business of Social Work Australia Facebook group - https://www.facebook.com/groups/1919283988289631/This episode's transcript can be viewed here:https://docs.google.com/document/d/1iQpjJWrfckSIqb4P2H97YQykQirSXOaCbRSI5vTxAbQ/edit?usp=sharingThanks to Kevin Macleod of incompetech.com for our theme music.

I begin today by acknowledging the Gadigal people of the Eura Nation, traditional custodians of the land on which I record this podcast, and pay my respects to their elders past and present. I extend that respect to Aboriginal and Torres Strait Islander people listening today. Aboriginal and Torres Strait Islander peoples have an intrinsic connection to this land and have cared for country for over 60,000 years, with their way of life having been devastated by colonisation. Hi and welcome to Social Work Spotlight where I showcase different areas of the profession each episode.

I'm your host, Yasmin McKee Wright, and today's guest is Alex, the owner of Mindful Recovery Services, a private practice providing psychological treatment and support for adolescents and adults. Alex is passionate about dispelling myths about mental illness and is highly skilled in dialectical behavioral therapy. She is an experienced public speaker and provides consultation to other professionals on difficult behaviors in teens. Alex lives on the New South Wales Central Coast with her partner, two young boys and a cheeky puppy named Axel. Thanks Alex for coming on to the podcast.

Really happy to make this time with you and just get a sense of what got you into social work in the first place and why you stuck with it. So thank you. Oh, thanks for having me. Can I ask firstly when you started as a social worker and what drew you to the profession? Yes. So I graduated from my Bachelor of Social Work in 2003 from Sydney, uni. So I went straight into uni from high school. I knew that I wanted to do social work.

I was actually, I was tossing up between psychology and social work, but I didn't want to do stats. And I knew that I wanted to do counseling. So I went to social work because that seemed like more of what I wanted to do. And yeah, so finish. my degree in 2003 and have been working as a social worker's consent. Is there something specific or was someone who perhaps was a mentor or I'm just thinking back my experience, I had no idea what social work was. I pulled it out of the UAC guide. I had a cousin who was finishing the degree as I was starting.

So I had a bit of an indication, but apart from that, I don't think any career advisor knew what it was even at my school. how did you know that that was something that was for you? Yeah. Well, yeah, that's interesting because when I was deciding what to do at uni, I wouldn't have called it social work, what I thought I wanted to do. I knew that I wanted to do counseling of some kind. And then when I looked into those options of psychology, social work, I realized that social work did a lot of those things that I wanted to do around,

you know, mental health training and helping. other people and that sort of stuff. So yeah, I actually wouldn't have called at social work until I got into the degree. Okay. And what were your placements? What experience did you have before you graduated? So my first placement in third year was at a hospital. It was on a general medical ward and it was so fantastic. I just loved it. And I fell in love with medical social work at that point. I had two supervisors who were phenomenal and still lifelong friends. And yeah, it was just a great experience. I met my husband on that placement.

He was working at the hospital. It was just, yeah, it was a great time. And I felt like I got a sense of all the different things that social work could do. Because as I said, I thought that I wanted to do counseling. But then when I did that first hospital placement, I thought, oh, actually, maybe I don't want to just do counselling. Maybe I want to do critical care social work or grief and bereavement work or, you know, a whole bunch of things that I got exposure to in that placement that was awesome. And then for my fourth year placement, I took an out of area placement. So I went up to Port

McCorry and worked with the Violence Against Women, Attorney General's project up there. and that was really eye-opening, getting experience in domestic violence, sitting on committees, doing research, having look at service provision and all that sort of stuff. It was very eye-opening in regards to seeing how much domestic violence was present, even within the professionals and the services that I was working with. Yeah, it was very eye-opening, a great placement as well, but in different ways. But it seems like it would have been quite confronting as a young up-and-comer. It was. I hadn't realized how prevalent domestic violence was in the community until that placement.

And I hadn't realized how dangerous it could be. As a worker? As a victim. So meeting victims of domestic violence and sitting on committees where we would sometimes review deaths, domestic violence, and we also had some people on those committees with lived experience, survivors of domestic violence. And before that, I just had no idea how many women died at the hands of their partner. Yeah. So that was quite shocking.

Yeah. Was there any point where you felt unsafe going in? No, no. That placement was more of a policy placement. So I didn't have that kind of direct clinical contact that made me feel unsafe. But there were, on some of the committees that I sat on, there were other members on that committee that it was well known were perpetrators of violence in positions of power sitting on those committees.

That was unsettling. Yeah. Did you have good support as in supervision to try to nuddle that out? Yeah, I had a really great supervisor who, yeah, was really supportive and would talk very openly about a lot of those issues. And yeah, she was really great. So I think in both my placements, my supervisors are what made it such a good learning experience. And did you have contacts in Port Macquarie? Like I'm just thinking as a student, it would be, you know, you're dealing with something that's very heavy in your placement, in your context, but then you're away from home.

you're not around your normal support networks. Yeah, that was hard. When I nominated to do an out of area placement, I thought, oh, this will be an adventure. It'll be great. And then when it came around to doing it, I was quite homesick. And my supervisor was really good, though. She could tell that I was quite homesick. So she would invite me over for dinner and we would do things sort of out of placement to try to have a bit of fun, which really helped. So she was a really good support. And then I, I also made sure that I kind of went back home every other, you know, every few weekends just to see people. But yeah, it was actually quite hard being away from home and not knowing anybody, not having sort of a social network for those four months.

Absolutely. I think it's a testament to your determination and the fact that you found that right fit from day one that kept you going and got you through the degree. Yeah. Yeah. I definitely would definitely. was lucky to have a supervisor who, yeah, really took me under her wing and was so supportive. Otherwise, I think I would have struggled to stay in that placement. But, yeah, she really made it. And so you finished the degree and was it the first rollout that you went back to the general medicine side of things?

So my first rollout, I actually got a job in an emergency department, an ICU, which was my dream job at the time and I managed to get the job. It was a locum. Somebody was going on leave, but the head social worker in the emergency department was friends with my supervisor from my first placement. And so it was kind of one of those, you know, who you know scenarios. And I managed to get that job, that locum and was just over the moon because that's where I was hoping to work my way towards emergency and critical care. So yeah, And that was actually at a hospital in the guts of Sydney. So it was lots of homelessness, lots of mental health, lots of drug and alcohol, like really needy-gritty stuff.

So yes, straight into it out of uni, which was a massive learning curve, but also really exciting and really enjoyable. And that would have been back in the day when Francis Taylor was in the department. That's right. That's right. Fantastic social worker. Yeah, yeah, that was great. And so I stayed there for a while doing kind of back-to-back locus when people would take leave. And that was good. They then had a change of management and things kind of changed. And so then I left after that and, yeah, moved into more mental health stuff. Because I spent quite a bit of time after hours, emergency ED. Oh, really?

ICU at the same hospitals. Oh, cool. I'm familiar with the environment. And it is very fast-paced, very, you've got very disadvantaged and also very well-to-do. You've got a huge amount of privilege and a huge amount of people who struggle with systems and have done their whole lives. So it is, I think, especially as a first job out. And in emergency and ICU, often you're the only person there.

And if it's after hours, you kind of, that's really difficult. a learning perspective because you can get sort of caught in a rut in a sense of doing similar things without that professional support behind you. But at the same time, the nurses and the doctors are incredible as well. They were. They were so welcoming and so supportive of me as a new grad. And when I went into the job, so the head of the emergency social workers at that time, me and him became very close. He was the one who was friends. He was the one who was friends. with my previous supervisor. So we were really close off the bat and he was amazing. And, you know, when things in the department were quiet, we would sit down and talk about ethical

dilemmas and different things. And he was just so generous with his time and his knowledge. And one of the things that changed later on in that job is that he left and that really changed things for me. I didn't feel very supported after that with a change of management. And so that made it quite hard. Yeah. So where did you go from there? So then I got married and was looking for work then for about three or four months and ended up going into a community mental health job, which was with what they call an assertive outreach team.

So it was like high level kind of chronic needs patients. Yeah. We had some group homes that we would visit. So a lot of schizophrenia, those sorts of illnesses. So, yeah, that was, obviously, I had some mental health experience in the emergency department, but this was very different mental health. And so that was my first mental health-specific role as a case manager on that team. And, yeah, I learned a ton about mental health, a ton about schizophrenia, a ton about medication.

And also the chronic side of things as opposed to the acute I'm coming into hospital because I'm acutely unwell. You would have then been needing to support someone through chronic illness and probably heaps of stigma in the community as well. Heaps of stigma. And it was so interesting because working in the emergency department prior, the stigma was there. It wasn't so bad at the hospital that I was at, but it was still there. when I moved into mental health, I could see that stigma on the other side so much more as well. And it was, I could see how much knowledge I had lacked in my emergency role in mental health. Yeah.

I really saw how little I had understood about mental illness in that role. So, yeah, that was very confronting for me. And it was a very different role as well because it was long. long-term therapeutic relationships rather than those one-off kind of things. Single session. Yeah. So you got to know the clients. You got to know their stories.

It was much more in depth. So, yeah, it was quite a change of pace. And I guess you also get a chance to develop a really good working relationship with some of those organizations. And even from the other side, it probably helped to advocate for someone who had been admitted to hospital because you would have known the doctors. you would have known the nurses, you know the system. So you've got a shared language or shared understanding there.

Yeah, it was interesting when I would then be, you know, escorting a patient into the emergency department and being on the other side of things and seeing that treatment. So this was in it, this was in the north shore of Sydney now that I was working on that team. And there was a lot more stigma there around mental health in that emergency department. And they didn't really see mental health as their.

their core business. So I had a lot of instances with clients where they would need an emergency admission and I'd really have to fight to just get them seen. So yet it was really interesting to be on the other side. And even though I knew the ED environment and I knew how they worked, it was very challenging for me to get heard, let alone the client. So it really opened my eyes to the massive challenges that mental health clients have with accessing service. Sure. Yeah. And you would know better than many people, I imagine, how the stigma carries through

medical records. So you might be doing really well. You might have amazing treatment, amazing support. But as soon as that diagnosis goes on your medical record, it completely changes the way that you're supported or not, I guess. Yeah. Absolutely. And, you know, we had.

clients. I had clients sometimes where their issues were purely medical, but because they had a mental health diagnosis, they would be seen by the mental health team, not the medical team. And it's like, no, no, we're here for a medical issue. I had a client once who accidentally overdosed on her tablets because she just took the wrong ones. And it was quite serious because she had some some pretty serious medical issues took her in and could not get her seen by just a medical doctor. They wanted her to see the psych reg. They wanted her to see the consultant psych. It's like, no, no, it's not a mental health issue.

Her mental health is fine. This is a medical issue. You need to do a medical workup. And we had big fights about it. Or sometimes we would have a client who was taken to emergency unconscious and we had to fight to have them seen by a medical doctor. They're like, oh, we'll wait for psych. No, the client can't talk. They're unconscious. It's a medical issue. So a lot of that stuff went on. Wow. Now, that was going back 2005 to 2010. I hope things have improved, but there was a lot of that back then.

Do you get the sense that there has been some change in that area based on other people that you speak with? So I think it's really variable. So now when I hear from my clients about their experiences in emergency departments, they sometimes have a positive experience, but they sometimes don't. So there's still a long way to go. Particularly, as you said, with clients who have a diagnosis and I consider chronic, they really struggle to get care because as soon as they show up and somebody pulls their file or they recognize their name and they say, oh, it's this person again. They're a frequent

flyer and they just turn them around and send them back out. So that happens a lot with my clients who have a lot of suicide attempts or a lot of self-harm those sorts of behaviors. There's still a lot of stigma around that. I think it's a little bit better now with PEC units. However, yeah, we've still got a long way to go, I think. Sure. And where to from that role? What was your next experience. So after the chronic community team, I then moved into another arm of community mental health, which was more acute mental health. So I guess what people call the crisis team, the community crisis mental health team. And that was a great learning experience for me, because I learned about all different mental health diagnosis and presentations, not just the chronic

ones. And I learned a lot about, you know, suicide risk assessment and suicide risk management. And suicide risk management, which is actually pretty complex. It's not as simple as asking some questions and ticking some boxes. It's actually quite complex to differentiate between a client that needs to go to hospital right now versus a client that we can manage in the community. So that was great learning. And I really loved that job until I stepped into the management role in that job. And then it wasn't so much fun after that, having to kind of wear two hats as clinician, team leader,

managing other clinicians was quite hard, particularly being at the time I was quite young. So being a young clinician coming into a leadership role was challenging. There was some resistance there from older members of the team that had been around longer. And I didn't feel very well supported in that. So, yeah, when I stepped into that leadership role, after about six months, I'd figured out that was not for me. And the relationships with that team, unfortunately, had dissolved.

So I couldn't just go back to being a clinician on the team. Right. So, yeah, that was really challenging. And I think that was the first time I'd experienced what I'd classify workplace bullying. It was pretty intense, even though I was the manager. I didn't realize that managers could be bullied. I thought it was always the other way around. But it was really tough.

It really took its toll on me from a mental health perspective, my own mental health perspective. And after about six months, I just had to get out of there. I'd had enough of that. A lot of people I've spoken with who have landed, and I say landed very specifically in a management role, have done so because it's just come up. Someone needed something filled or,

someone thought, yeah, you could step up into that role. Was that something that was always on your radar? Was it a goal of yours? Did it just happen? So it was on my radar because when I was a clinician on the team, I think I found myself kind of naturally in more of a leadership role at times. I was always putting my hand up for extra things and that sort of thing. But I thought it was a lot further down the track. And what happened was suddenly the team leader left unexpectedly and nobody else wanted to do the job. So I got the job. So it was much sooner. And I hadn't had any experience in even acting in a management role. And suddenly I had a team of 20 clinicians to manage. Oh, that's huge. Yeah. Yeah. And my manager wasn't a social worker. So I didn't get much support there.

I sought some external social work supervision, which was helpful, but they couldn't do anything about, you know, the team I was on. They just had to try and support me to kind of, you know, get through it and do the best I could. But yes, it wasn't a planned transition. It was one day I was in the role. And there was no let's start slowly. It was all of a sudden you're looking after 20 staff members. Yeah. And there were a lot of problems on the team. There were, some really chronic issues that had been ignored for a really long time around staff behaviours and practices. Things like, you know, inadequate documentation or medication administration that wasn't done the way it's supposed to be done, just things that needed

tightening up. And so when I saw those things and tried to address those things, it was not well received. So did that force you into kind of a soul search of, is this really what I want to be doing? Yeah, yeah, massively because it was so black and white. I'd gone from a clinician that got along well with everybody that was, you know, praised in their work to suddenly just being criticized and under fire every minute of every day. And I could not figure out what I was doing wrong. and I spent so many hours trying to figure out how to fix it and what I was doing wrong and trying this and trying that. And even now when I look back, I sometimes ask myself, like, what should I have done differently? And I still not sure, to be honest. I think it was

just the perfect storm of me at the time and them at the time. And it just didn't work. But yeah, I really took it very personally. Sure. As a personal failure, yeah. I can see how you kind of feel like you're failing or you're in some way inadequate because you've been asked to do this because people thought you were capable. But there hasn't been a lot of insight into all the other problems

that you're then having to deal with. Yeah. You can't possibly be expected to pick up the pieces when it's that situation. No. Well, and it was, you know, I thought I was taking a very gentle, slow approach, but I think I underestimated how scary that was for people that had been on that team for decades and had always done it one way. And even the hint of change really got their backs up. And so I really felt like I had no other idea how to approach it. It seemed like just my mere existence was inflaming the situation. So yeah, it was, it was really rough. And, you know,

some of the criticism that got thrown at me was very personal from people that I'd been really close friends with. All those relationships changed. And it went from a team where I felt very close and I considered them friends to me on the outside and like they would have meetings about me. Oh, that's horrible. Yeah, and then send a representative to like deliver a message and tell me what they all thought and, you know, things like that. I had people screaming in my face. Yeah, it was really full on. It was really full on. Did you take some time off after that?

So after that I didn't actually, but I, there became a social work role in the inpatient unit that was just sort of with the same service. Okay. that became available and I just walked over there one day and I spoke to the numb and I said hey you know is that role available if I wanted it and they said yeah great come on over and that was it so I just literally picked up my stuff and walked walked over okay yeah so which as soon as I did that I felt a weight lifted from my shoulders and it was I felt so much relief even though it was literally just two buildings away I didn't have to manage people in that role and it was a whole new team that liked me and didn't do mean things.

So such a basic thing really. Like it's not that much to ask. Yeah. But I can see you're, you know, very insightful. You probably went into it going full disclosure. This is what I've just been through. Please be kind. You know, just be mindful of if I react in a certain way. Like you would have had to be really mindful of your own immediate responses to certain triggers in that new role. And everybody on the new team knew what had happened. Because, you know, like everybody on my old team was very vocal about their feelings about things. So everybody knew, but thankfully they hadn't developed any negative views of me based on that. And they just met me, you know, and got to know me and were like, oh, okay.

like you're actually nice and you're actually good at your job and they did know that there was some issues in that team that had historically been there for a long time. So they could see that. So yeah, they treated me really well. They welcomed me with open arms and I was worried about that. I thought, am I going to be taking this reputation with me? But it wasn't like that, thank goodness. I got a clean slate.

And was the work similar in many senses? Because if you're going from the same health service to the same health service, just outpatient to inpatient, you'd imagine there'd be a lot of similarities there. Was that transition fairly easy? It was because I already knew how all the services worked together. I knew the referral pathways. I knew the policies and procedures. I obviously knew how to do mental health assessments and all that sort of stuff. So the only thing that was new in inpatient was, the legal process around magistrates and involuntary patients. So I had to learn that, but that was pretty simple. So yeah, it wasn't too much of a steep learning curve. It was a really nice transition. So does that involve things like tribunal hearings and going through those sort of legislative processes? Yeah. So the unit that I was on, the social workers were entirely in charge of notifying families about the tribunal process, explaining to patients in some detail, although we did also have access to patient advocates, setting up the tribunal hearings,

making sure that they ran smoothly, making sure that the lawyers were where they needed to be, the doctors were where they needed to be, reports were written when they needed to be written. So yeah, social work really ran that all the legal processes, which was great. It was, yeah, a really interesting process. And I think that social workers, we were really well positioned in that role because we take such an anti-oppressive approach. We really went out of our way

to make that process very transparent and as simple and stress-free as possible for the patients. So, yeah, that was part of the job I really loved. For people who maybe aren't as familiar, would you mind explaining the mental health review tribunal process, why someone might need to be part of the process and what the, I guess, the intended outcomes might be? Yeah, so basically the process is for anybody who is assessed to need involuntary psychiatric admission. So either they're not willing to stay in hospital, but the

medical team feel very strongly that they need to because they're a risk of harm to themselves or someone else. And that includes harm to reputation. as well. We had some clients who, when they were unwell, would go out and do things where they would lose their job or spend all their money and do things like that. So we needed to keep them in hospital to get them some treatment before they were safe to go back home. So basically the process would be that if a client came in, usually through the emergency department, they were assessed as having symptoms of a mental illness and having those risks of harm to self or others, then they would be kept under the Mental Health Act as an involuntary patient for a

period of time and usually just a few days. And then if the doctors decided, yes, we need longer to treat this person and they won't stay voluntarily, then they have to go in front of a magistrate and the doctor has to argue why that's necessary. And the patient has their say, the patient has a solicitor who is acting on their behalf, who will put forward a position of reasons why the client should be made voluntary or should be discharged. And so it's basically a mini hearing. And we would have them every week in the inpatient unit. Sometimes the magistrate would come out in person. And so we would sit in a little room. And the tribunal's always three people. So it would be the magistrate and then two other people usually.

a patient advocate and a lawyer and would have a mini-hearing. And every patient who the doctors felt like they needed to stay, it's usually a two-week stay that they would ask for from the magistrate, sometimes longer, but they'd come in front of the magistrate and the doctor would say their reasons and the patient would have their say, the solicitor would have their say, and then the magistrate and the tribunal would make a decision. Yes, this patient needs to stay for two more weeks or no, they can go. At 99% of the time, the patients were detained under the Mental Health Act because doctors really didn't want to keep people unless they really had to.

And the hearings are what we call non-adversarial. So they're not a hearing where, you know, people are arguing and it's really nasty. It's supposed to be calm and fair and balanced. And usually they went that way. And were there situations where the outcome was different to what you were hoping? Or perhaps you didn't agree with that? No, most of the time, it wasn't a surprise. Most of the time, the treating team, you know, me included as a social worker,

we would all be on the same page. And with the involuntary admission, so even if the magistrate granted a two-week stay, that didn't mean that the patient had to stay two more weeks. the patient could be discharged any time that the doctor felt like that was appropriate. So the two weeks was really a maximum. Sure. So we would do a lot of talking in those two weeks and say, okay, let's trial some leave or let's do this or let's do that. So yeah, I can't think of any situations where there was a surprise or a disagreement. It all ran pretty smoothly, mainly because everyone was

prepared for what was coming up. Yeah. The patients were. were not always happy, but most of the time they could understand why this order was being granted, even if they weren't happy about it. And again, we really stressed that it was a maximum that was being awarded, that any time in that two weeks, if things improved, they might go home. So a lot of patients were happy when it was explained to them in that way. Yeah. And what prompted you stepping out on your own, I guess, with your private practice from that inpatient experience to where you are now? So mainly lifestyle choices. I wanted to be able to work more flexible hours. And my husband and I, we decided that we wanted to live out of Sydney. And so it just sort of made sense for me to try

setting up a private practice while I was on maternity leave and seeing how that went, having the security of a job to go back to. But the private practice, it was clear from the beginning. There was plenty of work to support a private practice. So, yeah, it was just the timing of I wanted to have kids so I didn't want to work full time. I liked the idea of being my own boss. And I wanted to be able to work from home, which is, yeah, what I was able to do in private practice. So I actually got my accreditation, my mental health accreditation in the last couple of years before I planned to move and have kids. So I had that ready for when we had kids and I could take maternity leave and sort of experiment a little bit with the private practice world. It's pretty clever doing that so far ahead of time instead of being kind of forced to almost work on it full time when you suddenly find that role that you need to use it for.

so many people I've spoken with who have obtained that accreditation had to do it so quickly and have had to invest so much energy into it because all of a sudden they've found something that they want to do, whether it's time of practice or elsewhere, and have just had to devote so much time and energy to it to the point where they're just over it by the end of it. But it sounds as though you've thought so far ahead that you just thought, okay, I'm going to have it there because this is my longer term plan. Is that accurate? Yeah, yeah. And because the accreditation requires you to have, you know, a supervised sign off, say that you are practicing in focus, psychological strategies, you have to do all those things as part

of the application. That was much easier to do in my role in the inpatient unit because I was also running a DBT program in that role. So it just made sense to do that and get it all set up. and yet then move towards that goal. And I think it was easier when I did it. I think the application process was slightly shorter, but it still took, you know, a solid three months to put it all together and get all the bits and pieces that I needed.

It was still quite a process, but it was much easier given that I was in a role and, yeah, could easily get those things organized. And, yeah, then once I had it, I just had to keep my CPD points ticking over and yeah, I could use it whenever I needed. Okay. But you were again in a situation where there was a lot of change. You were a new mom trying to start your own practice. What was that process like for you? Yeah, big learning curve. I've never run a business before. So I remember waking up one night and thinking,

oh God, I think I need an ABN and like it hadn't even occurred to me. I might need an ABN. So, yeah, it was trying to figure out what I had to do to actually start a business. Doing the work was the easy part. It was all the business stuff that was a really big learning curve. So a lot of late nights on the computer, which I was having late nights anyways with my baby. But yes, a lot of time just trying to get things set up and figure out how Medicare worked, that was a whole thing, figure out how to process payments, just the basics that, you know,

we don't learn at uni. So, yeah, it was a lot of new learning. And do you support people mainly privately or is there a combination of government funding? No, so I do almost exclusively private work. I do see a few clients under victim services, but I limit the amount of those. So it's mainly, 90% is private clients. And a lot of them obviously come with GP referrals. So they get Medicare rebates and we process their rebates for them. And so we do have to interact with Medicare. Sometimes private health funds we have to provide some things for. And we do see some clients who are NDIS self or plan managed. So yeah, sometimes there's fiddly things around those processes and those systems and those are forever changing. So that's, again, probably the hardest

part about private practice for me is trying to keep on top of all of the rebates and payment issues. The actual therapeutic work is the easy part. Yeah. And is the conscious decision to limit the victim services an admin thing or is it your own sort of self-preservation thing? No, it was a financial decision because victim services only pay half of what my private fee is. Yeah, well. So I love working with victims clients, and I did a lot more of that when I first started the practice because I was just getting established,

and so I was happy to work for those lower rates. But as the practice has grown and my outgoing costs have grown because now I have admin support, I have another clinician who works for me. We run groups, we do online programs, our outgoing costs are much higher and we need to charge those higher rates. So the victims clients that I have now are basically people I've been working with for a long time that just for personal reasons I want to keep seeing. But financially it's very hard to run a private practice on victim

service levels of payment. Okay. And you've expanded as you were saying to make it more interdisciplinary, what are the different support services you can offer? So I've got a psychologist who contracts with me at the moment, but our practice, basically we are DBT specialists. I know I'm not supposed to use that word, but we are known for doing dialectical behavioral therapy. So that's sort of our niche. And so that's 90% of the work that we do. We don't do assessments or any psychometric assessments or anything like that. We do see other diagnosis. So my contractor shall sometimes see people with, you know, ADHD or standard anxiety presentations, things like that. But the bulk of our work is borderline personality disorder, self-harm. A lot of clients who have tried other treatments

and not had good outcomes, they are our people that come to us. The, I guess, difficult in air quotes, ones. Yes, we love the difficult ones. Yes. Okay, so I'm just also conscious of your years of traumatic exposure and the amount of support that you must have, but being in a private practice, that must be more challenging as well. How do you manage the responsibility of a practice plus your own self-care? Yeah, so it is really challenging because private practice can get very isolating. So I found I have to, and I still have to go out of my way to form and maintain professional supports. So I do peer supervision with a really great social worker who's just a couple of suburbs away. And we met through different channels and kind of hit it off. So we meet once a month.

We're actually going for our Christmas lunch tomorrow because in private practice, of course, you don't have a big Christmas lunch. So we do our own Christmas lunch together. Nice. Because she's in private practice too, just on her own. own. So relationships like that have been really important. So if I meet another private practice owner who's very like-minded and we get along, I really try and keep those relationships going. And so there's a few different practitioners. And they're not all in private practice. I've got some friends who work in the public service up here, who I just make sure that I keep in contact with and we catch up. And that's just really helpful.

They also tell me things that I might not know. So they might say, oh, there's been this change to Medicare or did you hear about this? Or I'll tell them about something. So that's really helpful. And then I also have found having a business coach super helpful. Okay. Because that's the part of private practice that, again, I just felt like I was floundering, trying to figure out how to run a business, which in some ways felt contrary to social work ethics,

you know, making money, seeing people, charging people. That was a really tough ethical dilemma for me to try and resolve. So I got a business coach who's also a psychologist and that's been very helpful at working out how to run a business, but also getting into a private practice mindset of how I need to make sure my practice is financially viable and that we can keep the doors open so we can help people. And if we don't charge enough, then I can't help people. You know, if I'm always giving discounts, if I'm undercharging, then the business will fail and I won't be able to help anybody. And she really helped me to change that, you know,

to see that mindset as charging money is not an evil, horrible thing that's anti-social work. it's actually a really necessary thing to providing a good private service. Yeah. So, yeah, that's been very helpful. Not cheap, having a business coach is very expensive, but has been really worth it for me. And just, yeah, putting value on your work, I guess, is where they've really come in. Yeah, yeah. I've needed to figure out how to take time for my clients, but then also time to work on the business

as a business owner because, you know, there was a time there. I was seeing clients, you know, six days a week and I had no time for the business management or thinking about marketing or programs or anything like that. So she made me get quite tough with myself and be like, okay, I need to cut down my clinical hours, get another team member in to help, which was hard. It's very hard to find good team. But once I did that, then I can have time to work on the business and now I also have time to do professional training for other social workers in DBT, which I'm loving. I'm really loving having that diversity.

Yeah. Yeah. So she's, her advice has been, it's been tough. She's been firm but fair at just challenging some of those mental barriers that I had up around what it is to be a social worker. And have you had to put really firm barriers like 40, 60 split, clinical management, or have you been able to kind of keep it fluid? So I have to be very strict with my diary.

So I have a static diary, which is every week, Mondays, Tuesdays and half days, Wednesdays are non-client days. So there's some flexibility in what I do with that time. So I have a usual schedule that I stick to, but that is the time that I don't spend with clients, that I spend working on the business or with other professionals. and then I have my client hours, half Wednesdays, Thursdays, Fridays and Saturday mornings. Those are my client hours and that's it.

So I have to stick to that. Otherwise, I'm just squeezing people in here and there. And before I know it, I'm back to six days a week seeing clients, which is not good for the business. Of course. What's been the best thing both personally and professionally of making this big change? Oh, look, I think it's been, for me, being able to set up and run a private practice, the way that I've wanted to do it has been really great. So being able to focus on DBT, which I love.

I've always loved the model. I think it's really powerful and really validating for so many clients. And it's just been so nice to be able to bring that model to more people and to see people. and to see people get better, it's just so rewarding to like build that yourself and then to see the outcome. And then to also be able to be in a position to teach other people. Yeah, it's just been great to become like this DBT person. That's been really great. And I think I also feel proud of, you know, figuring out how to run a business again, because that was something that I was starting with zero knowledge. That's felt really worthwhile to just build that skill set as well. But yeah,

overwhelmingly, I think seeing clients get better. A lot of our clients, you know, we see for one, two years. So we really see them through that journey of they come to us and they're so hopeless and they've tried everything and most of them have been in hospital lots of times and they're just really like, where like their last, their last try, if you like, last stop. And to see them get better is,

it's just amazing. It's so fulfilling. Yeah. If anyone's wanting to know more about the training that you provide, where should they be looking? Yeah, so they can go to my website, which is mindful recovery.com.

There's a professionals tab, and you can click on that. I also have a Facebook page where I do, lots of free training, and that's called DBT for helping professionals. It has a little Kermit the Frog sitting on a couch. Amazing. Yeah, so there's lots of free training in there and lots of great discussion. So yeah, either of those places, if you're interested in DBT stuff, that's where you can go. And I guess if someone's interested in further down the track,

looking into management or leadership training, do you have any good resources that you you could shout out. So look, I think if anybody's looking to get into private practice and they want to learn how to run a business, I worked a lot with NASS, she's not a social worker. She's a psychologist, but Gerda Muller, she's got a lot of stuff on Facebook. She's got what she calls private practice success academy. If you Google her, she'll come up with all sorts of things. So she's who I used to just build up my leadership and business skills. And she was, invaluable. Again, not cheap, but worth every cent. So yeah, I don't know about social workers in the space. I hope there's some social workers out there, you know, helping other social workers in

business, but I think there should be more of us. Absolutely. And even for people who maybe, let's say it's on their professional development plan to do some team leader work or just anything within their existing setting, is there anything good out there that people could link into? Oh, that's a tricky one. Because again, I feel like it's something that people are thrown into fairly unprepared and just kind have to figure it out as they go along. Yeah. I can't actually think of anything because, yeah, I don't think I've ever done any leadership

training. I've just fumbled my way through. I think some of the Facebook pages. Now, these weren't around when I was coming into leadership and that sort of thing, but Facebook pages like the business of social work, that's a really good resource. So that's just a group of social workers who work in private practice. But there's often good advice in there about, you know, getting into different areas or professional development opportunities and who would you recommend. So I stay pretty close to that group. That's where I go when I have.

tricky questions for things. No, that's fantastic. I'll find that resource and I'll pop it in the show notes. Are there other areas of social work that you've always been curious about, that you've always worked in mental health, but if you were to expand it at all, what would it be? Oh, look, I have had an interest, and it's probably harking back to my emergency department days, but I did some training back in the day with the coroner's court around,

disaster victim identification. And it was just after the Bali bombing had happened. And there were some social workers that I had worked with that went over as part of the disaster victims service, worked with families that had lost people. And the training that I did with them was amazing. And I think that's an area. Yeah, that's always interested me that if I was going to do something else, I think I'd probably want to do something like that. Yeah, it's very interesting. And even though it's pretty tough going, like it's heavy work, but again, really rewarding to be able to support families in those incredibly intense experiences.

Yeah, absolutely. And before we finish up, is there anything else about social work, about your experience, any words of wisdom, anything else that you wanted to share with the listeners? I think, you know, generally what I've found being a social worker is the most valuable thing is to make those, you know, personal and professional connections and to keep them. So again, you know, I still am in touch with my first ever supervisor, you know, from my third year placement. And along the way, just finding those other social workers who I just felt that connection with and we just clicked on a person. personal and a professional level and just maintaining those friendships. I think that's really important,

particularly if you're a new social worker starting out, you know, find those people that you click with and just keep them in your life because I've found having those social workers at different times in my life personally and professionally just so valuable. Because social workers get it, you know, they understand what it's like, you know, no matter what. what field you work in. So yeah, I think that would be my number one piece of advice. Make those relationships and keep them with other social workers. Yeah.

Perfect. Yeah. And I guess from what you've been telling me, it's clear there's been a destiny. There's been a sort of clear pathway from day one of I want to support people who have gone through negative experiences. And so much of your work has been with people who have struggled to get care. they've tried all the other options. And what you've done throughout your career is develop a really good understanding of the support needs of people with mental health diagnoses.

So it's how are we diagnosing, how are we recognizing, how are we supporting? It's that holistic stuff that we're so good at. But also you've had the opportunity, even though you've kind of been thrown into it, you've had an opportunity to sow seeds for change within working environments. So there's only so much that you can plan for, you know, being a leader, being a manager, but you've just gone and done it and tried to pick up the pieces. And I think that's incredibly valuable experience. Yeah, that experience, you know, being thrown into that leadership role, even though it was really hard, it gave me a lot of empathy for other people,

you know, stepping up into those roles and understanding how hard that can be. when you kind of feel like you're all out on your own. Yeah. Trying to figure it out. And same with, you know, starting my own practice, you know, those times of just feeling completely out on my own. Like I have no idea what I'm doing and just trying to find those people that could help me. Yeah, I think it's given me a lot of empathy for other people in the same situation.

And that's, I think, why I love working with other social workers and other professionals now who are maybe thinking, oh, I think I want to get into DBT or I want to find out more. Maybe I want to go into private practice. I'm not really sure. And being able to talk to them about, you know, what is that dream and where do they see themselves going and how can they get there? Like I love those conversations because I think it's so helpful to have those conversations with people that have maybe walked that path a little bit before you or have some experience

with that. Yeah. Absolutely. Yeah, you've had multiple opportunities to foster professional relationships, and that helps you keep abreast of changes, funding, and what you were saying about finding your tribe, I guess, the people that you feel a connection with has been so important for your continued development.

And even just you learn from each other, right? So they'll learn something from you as well as you gaining knowledge from them. So true, so true, yeah. Amazing stuff. Thank you so much for sharing your experience with me. I think it's been incredible and, yeah, I really look forward to seeing how the practice develops and hopefully more different disciplines can come on board soon.

Yeah, oh, look, I'm always looking for people. It is so hard to get good team. So, yes, I'm hoping that, yes, more social workers will want to move into private practice DBT and anybody who's interested, just hit me up. We need people. There's plenty of work. Fantastic. Thanks again, Alex, for your time. Really appreciate it. Thank you so much. Thanks for having me.

Thanks for joining me this week. If you'd like to continue this discussion or ask anything of either myself or Alex, please visit my anchor page at anchor.fm slash social work spotlight. You can find me on Facebook, Instagram and Twitter, or you can email SW Spotlightpodcast at gmail.com. I'd love to hear from you. Please also let me know if there is a particular topic you'd like discussed, or if you or another person you know would like to be featured on the show. Next episode's guest is Patty, who began her social work career as a domestic violence counselor before moving into child protection for children in foster care and out of home care. Patty is an external supervisor for social work students at the Australian Catholic University

and has had her private counselling practice for 15 years. Patty is also a wedding celebrant, retreat host, workshop facilitator, coach, counselor, Reiki Master, Energy Healer and Senior Yoga Teacher. More recently, she began hosting a podcast called Carer Conversations to help provide support and inspiration for carers who care for their loved ones in the aging, mental health, addiction and disability sector. I release a new episode every two weeks. Please subscribe to my podcast so you'll notify when this next episode is available.

See you next time.