The Aspiring Psychologist Podcast - Working psychologically with serious and catastrophic injury

Starting point is 00:00:00 Hi there, it's Marianne here. Before we dive into today's episode, I want to quickly let you know about something exciting that's happening right now. If you've ever wondered how to create income that works for you, rather than constantly trading your time for money, then you'll love the Race to Recurring Revenue Challenge with my business mentor, Lisa Johnson. This challenge is designed to help you build sustainable income streams. And whether you're an aspiring psychologist, a mental health professional, or in a completely different field,

Starting point is 00:00:32 the principles can work for you. There are also wonderful prizes to be won directly by Lisa herself. And if you join the challenge by my link, you can be in with a chance of winning a one-to-one hours coaching with me, Dr. Marianne Trent. Do you want to know more? Of course you do. Head to my link tree, Dr. Marianne Trent, or check out my social media channels, or send me a quick DM and I'll get you all the details. Right, let's get on with today's episode. What is the role for psychology in catastrophic injury cases and what is case

Starting point is 00:01:08 management and how can that play out as a psychologist? That is what we are going to be exploring in today's episode as we meet a qualified clinical psychologist who specialises in all of this. There's so much to learn about compassion, dignity, respect and doing a job well. I hope you will find this so useful. Welcome along to the Aspiring Psychologist podcast. I am Dr. Marianne Trent and I am a qualified clinical psychologist. One of my favourite things about psychology is just how people can take essentially the same qualification and turn it into something completely new and unique from what another qualified professional might be doing. That is exactly what is going to be happening today.

Starting point is 00:02:00 We're going to be meeting someone with the same professional qualification as me, which is clinical psychologist, and we're going to be seeing about the work that she does and how she does it and why it lights her up. I hope you find it so useful and I'll look forward to catching you on the other side. Hi Shabnam, welcome along to the podcast. Thank you for having me, It's exciting to be here. So you are a qualified clinical psychologist, aren't you? I am, yes. So I qualified in 2008, which makes me feel incredibly old. But I like to think of myself as wise and experienced now. So yes, yes, I've been qualified for a little while. Brilliant. Could you tell us a little bit about your journey to psychology?

Starting point is 00:03:00 So I recognised that psychology was something you can actually make a job out of when I was at school, aspiring to be a medical student, actually, and to be a doctor. That was kind of my ambition at the time. And I realised quite soon into my A-levels that I'm not going to get there. I'm not a straight A student. And also, I really don't understand chemistry and biology like I probably should if I'm going to be a medic and then I started thinking about and I didn't realize this is the first foray I suppose into understanding values and the importance of values started thinking about you know what do I actually like doing what what interests me what gets me going and I came to a bit of a dead end until at school someone came and spoke to me um to speak to the school about um sort of like in a motivational interviewing kind of way sort of motivational

Starting point is 00:03:52 speaker and I just thought wow to use words so powerfully to change how people feel is an incredible um position to be in and how you can use that for good. And I don't need anything. I just need my words. And so that's kind of where the psychology came from, the idea of doing psychology. So my first introduction into psychology was actually at university. And that's where I learned about clinical psychology. And my journey to clinical psychology was actually via a PhD. And then I became, yeah, I got into clinical psychology training and here I am doing two different things, but using very much psychology skills nonetheless. Thank you for that whistle-stop tour.

Starting point is 00:04:39 So you are Dr. Dr. Shabnamberi Khan. I am, it seems. Or Dr. Square, as my friend calls me sometimes. You must have been a really good support to your cohort as well in terms of your academic rigor and your research skills too. I know that I would have loved to have had somebody in that regard on our cohort too. Yeah, it was, um it was it is a really good set of skills to have I don't necessarily think you need to do a PhD to have the you know to develop an interest and a passion for research but I think that has carried through um certainly that sort of background for sure so yeah it's um it's a good it's a good set of skills for sure certainly is right so let's have a think then without obviously giving away any client case

Starting point is 00:05:33 studies because that wouldn't be appropriate but could you give us a couple of examples about what serious and catastrophic injury looks like because that's the area that you're working in at the moment yes that's right so I work both as a treating psychologist in the serious and catastrophic injury field and a case manager in the same field so it's sort of two ways into the same client group um but um in terms of if I can give you a sort of a picture of the kind of work that we do do, and then hopefully that will bring, you know, a sort of helpful case study to mind. So the work is very systemic. It's ultimately so when we're thinking either about case management or treating psychology, you are working with people who have suffered a life changing injury. So that means that they are not living the life they would have had had it not been for the injury. And therefore,

Starting point is 00:06:33 in order to rehabilitate or to try and achieve their life goals, which they should absolutely be supported to try and achieve, there's an awful lot of systemic input that needs to go in. So I'm talking about therapies, of course, care. In my field, because they are seriously and catastrophically injured, often liable to someone else's mistake, there is a whole legal machine going on around them. So there's a lot of there are a lot of people involved in trying to get someone to live the life they should have been living. And so as a case manager, you're managing that entire package. And there's a lot of formulation work that goes into kind of um pulling all of that together as you can imagine

Starting point is 00:07:25 anyone who's kind of trained in or interested in systemic working there's a lot of um interpersonal dynamic uh features that that you draw upon and kind of pulling that story together having a narrative that everyone's working towards is super important um in my opinion um and as a treating psychologist you are then one of the team members so you would be the treating psychologist supporting again usually the system as opposed to specifically the client although there are obviously occasions where you are supporting the clients themselves if they have the capacity and the goals and the outcomes are related to specific work, you know, that they are, that we're working on together.

Starting point is 00:08:14 So I guess I'm thinking if we work and we do work across the lifespan as well, but you can, as you imagine, the systemic focus is different when you're working with paediatric clients. There is a lot of interagency working schools, sort of any community type input, statutory services, of course. Obviously, you've got the family who are in a very different position working with a child client than the family working, you know, when we're working with an adult client. So there's already, I hope that picture kind of suggests that your lens is quite broad. While you have the potential depth to work with a client who perhaps is struggling with the injury that's happened to them, that may not always be the case. So the work that you do is often very systemic and very trauma, needing to be trauma informed as well. In terms of a case specifically, a good example perhaps of a case could be a particular client.

Starting point is 00:09:30 So it's a case managed case that I work with. And one of our treating psychologists is the psychologist on the team as well. And the referral for psychology came through because the the clients, the client was experiencing was exhibiting behaviours of challenge. But in order to understand how how to to think about the function of that behaviour and the communications around it, there was a lot of interdisciplinary working with the speech and language therapist for example um there was um communications with the care team who through that discovery we worked through those interactions we worked out that the care team actually didn't have a lot of brain injury experience um and this client was unfortunately did have a brain injury as a result of the accident that happened and the what was happening was that the staff retention was very poor as a result

Starting point is 00:10:36 and so the psychologist and me as a gaze manager we were working in unison to try and understand how to create a stable team before we can even think about what the behaviors are about specifically because the system wasn't quite right we had to get mum and dad on board with that and so there was lots of joint working and lots of thinking around how they were relating to what had happened to their family member. We also had to check in a lot, a number of times with capacity. So the client, as I'm sure a lot of your audience will know, that capacity is time specific and decision specific. So we had to really bring that into how we were thinking around the client's needs, linking in obviously with the legal team who wanted to understand

Starting point is 00:11:34 what we were doing and why we were doing it, as well as thinking with the rest of the sort of therapy team so they understood how we were making sense of the behaviours, but needing to do this sort of pre-emptive piece around stabilising the system in which the client was operating. It got really complicated at one point, but between sort of the psychologist having a really strong formulation that everyone bought into, and from which there was a sort of shared understanding of what the goals are that were based on what the client was wanting we were able to well we still are navigating through how to work in unison and with the client rather than to the client and so it's been a really long piece of work. I think that one of the biggest differences of working in our field is that there's a lot more liaison, particularly with the legal teams, because they're the ones who are collating all of this data that you're otherwise generating and having to justify it, either from a cost perspective or in terms of what usually in a cost perspective, but in terms of clinical advantage,

Starting point is 00:12:45 like why would you spend that time thinking about stabilising the care team? And so you end up being quite analytical in a different way to perhaps if you were working purely clinically with a client. Does that make sense? Yeah, it does. It's a very big job, isn't it? And one with many different plates spinning simultaneously I think but um you know I think what we're talking about here is like big big accidents at work big accidents in education settings basically anything that's not your fault that might be like a serious acquired brain injury or maybe even you know someone having to be a wheelchair

Starting point is 00:13:25 user for life and or both that's kind of the level we're we're talking about here is it Shabnam? Absolutely often our clients are injured as a result of medical negligence and so we get a lot of birth injuries for example or um clinical negligence um you know procedure going wrong and leaving someone either as you say with spinal cord injury orthopedic injuries or a brain injury is is big sadly um and it could or it could be a road traffic accident that's our usual sort of um uh sort of incident sort of uh you know categories you could say you're right things happen at work things happen in other localities as well um uh settings so it's it's um injuries can happen anywhere it's more prolific i think than we perhaps might otherwise imagine yeah yeah thank you and how do you keep so positive and hopeful for what

Starting point is 00:14:28 might sometimes feel like a really really emotive challenging role that you're doing I think I suppose it comes back to that values piece right at the beginning really knowing what interests me and how I can make that um operational in my life um and it's taken me a really long time to get there because I didn't quite realize that was actually on the right lines way back when um and then you get distracted don't you and then suddenly you're in that um place of needing where it matters because actually the clashes and the conflicts become more apparent the you know the more you live life I suppose and then other priorities kick in family and you know just wanting to be me turns out that that's quite important and I needed to build time in so I think there are several transitions that happen.

Starting point is 00:15:25 So it's not just the mindset side of things. It was also kind of where I was working and how I wanted to work and where would I get that best work life balance? And I think for me, I realised there was a gap in the market, so to speak, in terms of psychology, supporting these catastrophically injured clients and thinking, why is there a gap in the market? This is outrageous. But I was working as a case manager at the time, so it was my way in. But I kind of smelt what sold, so to speak, to use an Alan Sugar term. And it was quite clear that this service was not available either in the NHS in that long term way. And it wasn't otherwise seemingly obviously available in the private sector. And so that positivity comes from, I think, wanting good things for our clients but in the process of that and giving things to our clients that

Starting point is 00:16:26 they need and and the systems around them but also being able to you know kind of have something that's reasonable for me as well to be able to stay myself in but I don't know am I really answering your question yeah I don't know no absolutely you are and you know I think you're also illuminating some people say if you can't see it you can't be it but you're actually reckoning you're saying well I can see I can't see it so I can be it and you've kind of given yourself permission to go out there and and create that unique service for that niche that was already there that nobody really noticed was there yeah I think um it yeah it was a it absolutely and I think um when you when you are in touch with that passion and when you are in touch with that um desire to help which is obviously why we do what we do ultimately I think

Starting point is 00:17:18 it it was it was obviously a bit easier because I sort of fell into the case management world and then realized gosh there's this area that I can really help with. And I suppose it took courage to be able to do that as well. But I think, I think, yeah, it's, and it's really challenged me in terms of kind of thinking outside of what I've been trained to do and thinking oh I've got to think about other things like KPIs and you know how do I be the how can I run some how can I create something that also doesn't lose me in it but how do I get others to sort of how can I use the resources that are out there in the world to be able to help so it you know where I didn't think I was a creative person I'm actually creative in this way I think you know don't give me you know any drawing material because I will not draw anything for you that's you know resembles anything that I say I'm drawing

Starting point is 00:18:14 but you know it the creative element in me comes out I think here when we're talking about how to create something to offer people that they wouldn't otherwise get perhaps um and yeah that that's massively motivating for me oh absolutely yeah and I also don't think I'm particularly creative but there are many many things I do create and um for listeners of the podcast they will have um probably maybe already listened to an episode which as we record is coming out imminently but isn't currently available right now but it's with Juliette Dr Juliette who is creative clinical psychologist over on Instagram and she's wonderfully creative I don't know if you've seen her drawings but she's they're so good they're so good you should

Starting point is 00:19:01 check them out I'll send you a link um she's so good and the way that she kind of depicts clients experiences um so she's currently working um with services with children and um asylum seekers and the way that she kind of weaves that into her work but she also makes the work available for people to be able to use with their clients as well like um but I love that she's a clinical psychologist i'm a clinical psychologist you're a clinical psychologist but we all do different things you know that speak to our individual passions and our callings it's so important isn't it we're not just cookie cutter clinical psychologists i 100 agree with that in fact you could argue i mean my of my caseload

Starting point is 00:19:46 the bigger part of it is case management which i didn't know about um when i was training that's for sure and i think we can also lend our skills to not just psych sort of therapeutic um endeavors that there are other ways that we can use our skills. And I think that's the really exciting bit about being a psychologist in training now compared to back, you know, when I was doing it, it was a bit more sort of standardised, if you like. But now I think, you know, there's a bit more acceptance that there are lots of different ways to do psychology and they're all legitimate and um I think it's it means that you from the probably from training onwards you you get to think like that from the off um whereas I think I'm not sure that that was so strongly felt at

Starting point is 00:20:40 least certainly I didn't feel that particularly strongly when I was training um so yeah I'm kind of envious of trainees now in a way that you know if that's indeed how it is which I yeah it sounds like it might be yeah I think the pandemic has really exploded and advanced all of this hasn't it with the way that people are working and with their yeah like some some people have kind of myself included no longer work for the NHS at all um you know or or other organizations you know they might only be self-employed but many clinicians are doing a little bit of both you know a bit of employed work and a bit of a bit of their own work as well and it's I think encouraging us to use our psychology skills in ways that suit ourselves as well as the needs of our clients. And it's really empowering. Yeah, absolutely.

Starting point is 00:21:30 In fact, I had a call earlier today with someone who was interested in working as an associate for us. And we we provide quite a lot of information up to the point of, you you know deciding if we're aligned in terms of our interest and um and one of her reflections was that it feels like not everyone can work in the field that you work in and i thought that's exactly why we produce all this information we don't want to waste anyone's time we certainly do not want to put our clients in a position where they're working with someone who then pulls out because it's not a good fit for them so in a way we are requiring our associates to kind of know themselves as well and know what their passions are know what their interests are and know that working certainly in our field with the systemic focus does require home visits for example it does

Starting point is 00:22:20 require um creative thinking training for care teams psychoeducation for the families, all of that stuff. And in a way that if you can explain it and justify it through your clinical formulation, pretty much if it makes sense and there is that motivation from the client themselves, the funding will probably be there to be able to kind of work through those challenges and those goals that have been identified, which is an incredible way to work. And like you, I'm not in the NHS anymore, but, and it's been a little while since I have been, but it's, it does feel like it's almost, you know, very different. Yeah, it's just very different to how we've been trained to work, I suppose. And so that creativity does need to be sort of on point in a way. But at the same time, you know, you can work in similar ways in the NHS, but just not for the length of time, I don't think. Certainly that's a feedback I've heard from associates and that I've experienced myself that it's not a sort of 12 sessions limitation due to

Starting point is 00:23:25 you know funding issues or just the way you know the system's set up it's it's so much more than that and if it's justifiable and it makes sense to the client and it ultimately as we often say with psychology prevents other problems from happening a bit later down the line it's worth front loading if you psychology support so that you prevent other things from happening a bit later down the line it's worth front loading if you psychology support so that you prevent other things from happening later on um and you get that stability which obviously our clients need and deserve yeah and anyone in all five whilst none of us are are you know can control or predict the future it's you know we have to be kind of entering into this work thinking that we can go the distance because I'm thinking that some of these cases

Starting point is 00:24:10 maybe even I don't know five years is it like you know how long is the longest case you could work with or could it be longer than that? Really good question so my longest standing case management client because it's a lifelong injury, as you say, and I started working with them as a paediatric when they were a child. I have been with them for the last 14 years and it doesn't look like we're going anywhere. So we're talking very long term. Psychology, our treating psychology work is a bit different but there are clients who because of the nature of their circumstances and the complexity around them easily a couple of years of different things you know working in different ways so yeah so for a case where you might be working with somebody with a legal team and case management

Starting point is 00:25:05 for for 10 years ultimately the goal would be that there'd be some sort of settlement and then the case management aspect would stop or or not what does that involve yeah I mean it really depends so it depends on things like what their experience was up to the point of settling, whether case management and the support they got was consistent and safe, felt safe for them. It might be it might depend on how well the evidence was collated up to the point of settlement, because, of course, post settlement, then the compensation will be whatever size it will be accordingly but obviously if there isn't any data and the engagement hasn't been there in order to get that data it might be that the compensation is a small award ultimately and that can't afford case management or other parts of the package and so there are big decisions to be made at the point of settlement. But often, if there is a case manager involved, an engagement is pretty decent from the client and the family.

Starting point is 00:26:13 And of course, the case manager is able to get the relevant data from other parts of the system, like the care teams and therapy teams, and can coordinate that well um more often than not the compensation will allow for the relationships to continue post settlement um and so because of the understanding that uh it's a lifelong um condition um um yeah that they will you know they would need the support for life okay so when you say data it's making me think about something I heard on the Jeremy Vine show the other day where it's saying that currently there's some health workers taking I think it's the government to to the high courts over long Covid but that's very tricky because they'd need to be able to prove without doubt that this had happened as a result of, they'd caught COVID as a result of their work, that they hadn't caught it elsewhere, for example. So when you're talking about data, that would be the data that they'd be having to produce, which is very tricky to do because, you know, because we just, you can't know that for sure.

Starting point is 00:27:24 You can say on the balance probability but for that sort of case you have to be certain so is that what you you mean by the data some stuff to back up your claim that it was it was someone else's responsibility rather than the the person um so when a case manager is, it's after the point of liability being assigned. So that bit that you're talking about is quite early on in the sort of pathway in the life cycle of a case manager's involvement. So once liability has been assigned to someone else causing the injuries. Money is then released in order to allow rehabilitation to commence because these cases can go on for years. Someone can't wait for rehabilitation for that long.

Starting point is 00:28:16 So some funds are released. And the idea is that those funds being released creates clinical data, outcome data. It produces evidence to demonstrate that the client actually needs that support. And so that's the data, I mean, that feeds back into the litigation strategy that then gets chewed over by the litigators and, of course, the defence solicitors to work out whether that's justifiable whether that's not justifiable whether that's been helpful whether it's not been helpful and that and that's partly why it goes the legal case can go on for so long because you need to

Starting point is 00:28:57 work out over a period of time just how much is needed and obviously clients need to change people can start improving um and making positive changes others decline because of you know health conditions that ensue after their injury um so on and so forth complications and all sorts and so there needs to be a reasonable picture over a period of time as to what has been going on. Does that make sense? I'm with you, yes. So the data might be, for example, actually physiotherapy five times a week and speech and language therapy twice a week is keeping this client rehabilitating and to withdraw that would be detrimental to their well-being. So we need to make sure there's enough budget for that to continue. Absolutely and the experts that come in and get that snapshot picture of the client will have the

Starting point is 00:29:54 view of across their lifespan and so it needs to be scaled up for the x number of years that this person is expected to live and unfortunately unfortunately, in some cases, injuries can be life limiting. Okay, thank you so much for clearing that up for us and really clarifying and helping us paint that picture. Could you give us and our listeners your top tip for reducing burnout when you are an aspiring psychologist or mental health professional? Yeah think um so my top tips would be um whatever you do make sure that there's space for you in that um that offer um and I think it's very easy to get carried away with your passions with your interests for filling a gap in the market if you like um for you know with all that enthusiasm um it's very

Starting point is 00:30:47 easy to get to a point of recognizing that actually i haven't built into this picture what i need in order to sustain all of that good stuff because the chances are if it's you know something you're doing it's probably going to be benefiting other people you don't want to do that for a short term you want to do it for the long term so build you know be okay about building yourself into um you know what that model is going to look like ultimately part-time working full-time working family commitments you know so on and so forth um and i would say related to that you don't have to do everything yourself um asking for help sort of delegating to specialists out there that can help you and i always use the example of a virtual assistant you know it's i mean they are a godsend frankly having someone who can assist you to do the things

Starting point is 00:31:43 that let's face it i'm no good at because I'm a psychologist I can do that but not so good at keeping my diary well you know that I thought we were meeting half an hour earlier than we actually were yeah people like me need a VA and I can spend a very long time focusing on things that get me stressed out number one and number two aren't going to get done well let's be honest and number three take away from the actual thing that i can do my specialism if you will and so outsourcing is okay it might cost but it's worth doing that cost benefit analysis in terms of what can i gain if i'm freed up for that hour yes i'm paying x amount for someone to help me with that

Starting point is 00:32:23 but that also means that i can think about doing something else and that something else might not even be you know a business something else it might just be I can go for that walk that I keep saying I want to go and do so those would be my two main sort of suggestions I think they're not sort of suggestions, I think. They're not sort of typical self-care and, you know, ideas that you would, you know, kind of, you know, not the go for a swim and, you know, go to the gym sort of ones. But I think for me, they've really helped ground me and helped me feel very sort of aware of what is important to me. But I think in, I suppose the, I suppose it could be a third thing,

Starting point is 00:33:12 but it's kind of interlinked is just, you start then finding people who are like you when you know what your values are, you know, and you're giving time for yourself to be able to be expressed. And then you end up sort of connecting with people that you align with, and that's a really nice way to live life. I think good people, good balance and space to do whatever you need to do as well, because it's that oxygen mask on your face before you start helping other

Starting point is 00:33:43 people scenario, which I'm sure many people have said in your podcasts over the over it really matters doesn't it really really matters that's my version of it um i would say as it turns out i am also swimming a lot more than i used to which is really really great um and that helps with um you know with that side of things as well in terms of physical exercise and um well yeah that's yeah that side of things brilliant and if people want to know more about you and your case management or case management as a topic i know at one stage you had a podcast called the psychology of case management can people still listen to that yeah it's on the website um it's under our resources tab. Yeah, there's a whole load of information on there. There's

Starting point is 00:34:29 various articles and fact sheets about working in the serious and catastrophic injury space. And with that psychological spin, of course, because that's our jam at the end of the day. But yeah, it's a it's a really great field to you know, if anyone's looking for, you know, sort of paid assistant work, case management is a really interesting field. Even if it's not psychology in the treating psychology sense, it's absolutely a field that you get to learn a lot about. Rehabilitation, brain injuries, spinal cord injuries, etc etc and systemic ultimately such important work and you are over on linkedin which is where i first connected to you your company is called psych

Starting point is 00:35:11 works associates and on linkedin you are dr shabnam very calm with a hyphen aren't you so people can come and follow you there brill thank you i will make sure I link to all of that in the show notes. But thank you so much for helping illuminate me as well, but our watchers and our listeners about the work that you do as a case manager and for people with serious and catastrophic injuries. Keep doing what you do. Keep lighting up my LinkedIn as well. It's lovely to see you again. My pleasure.

Starting point is 00:35:44 Thank you so much and all the best to your audience. Oh, thank you. What an absolute pleasure it was to meet Shabnam and I hope that you will go and follow her over on LinkedIn. If you're on LinkedIn, and you certainly should be, come and follow me too. I am Dr. Marianne Trent everywhere. What has this episode evoked for you? What's it made you think? Do come and let me know in the Aspiring Psychologist community free Facebook group. If you like this way of learning, thinking about novel and important concepts in psychology, including ethics, including formulation, including smashing interviews and application forms out of the park,

Starting point is 00:36:25 do please consider coming along and joining the Aspiring Psychologist membership. Don't forget the books as well, the Aspiring Psychologist Collective and the Clinical Psychologist Collective too. And if you're looking at how you can work out how to get qualified therapist, check out Talking Heads. My pleasure to bring you this podcast. The next episode will be available from 10am on Saturdays on YouTube, and will be along from 6am as an MP3. Thank you for being part of my world. Take care. then let this be your guide with this podcast that you'll find you'll be on your way to being qualified it's the aspiring psychologist with dr marianne My name's Jana and I'm a trainee psychological wellbeing practitioner. I read the Clinical

Starting point is 00:37:34 Psychologist Collective book. I found it really interesting about all the different stories and how people got to become clinical psychologists psychologist it just amazed me how many different routes there are to get there and there's no perfect way to become one and this kind of filled me of confidence that no I'm not doing it wrong and put less pressure on myself so if you're feeling a bit uneasy about becoming a clinical psychologist I'd definitely recommend this just to put yourself at ease and everything will be okay but trust me you will not put the book down once you start.

The Aspiring Psychologist Podcast - Working psychologically with serious and catastrophic injury

There aren't comments yet for this episode. Click on any sentence in the transcript to leave a comment.