Burnout in private practice with Dr Paula Redmond

Today, I'm really happy to be back after my break and talking to the wonderful Dr Paula Redmond. Paula is a clinical psychologist who specialises in burnout, which is a very pertinent topic for me right now, as I recently took a bit of a break from the podcast and my social media profiles because I managed to burn myself out. 

Paula is an extremely helpful and knowledgeable psychologist, she's a member of the Do More Than Therapy membership, and we've done some coaching together. I've been desperate to have her on the podcast for ages to talk to us about burnout, because I know it is a big problem in private practice, and it doesn't end if we leave the NHS.

Full show notes and a transcript of this episode are available at The Business of Psychology

Links for Paula

Website: DrPaulaRedmond.com

The Burnout Toolkit: drpaularedmond.com/the-burnout-toolkit

When Work Hurts podcast: drpaularedmond.com/podcast

Creative Restoration Retreats: creativerestoration.org

LinkedIn: DrPaulaRedmond

Facebook: DrPaulaRedmond

Twitter: @DrPaulaRedmond

Other Links

Psychology Business School

The highlights

• I introduce Paula and she tells us who she is and who she helps 00:17
• Paula explains what Burnout is and what it really means 02:07
• Paula give us some examples of situations that might occur in the workplace that would be likely to lead to burnout 08:14
• Paula talks about the five profiles of burnout beginning with the overload pattern 18:05
• Paula tells us about the detached pattern 24:52
• We discuss problems around well being initiatives and movements 31:23
• Paula tells us about the self doubting profile 36:58
• Paula tells us about the traumatised and moral distress profiles 38:30
• I ask Paula what we can do after we recognise this stuff in ourselves and she tells us about compassion, connection, and creativity 43:38
• Paula tells us about how she’s working with people at the moment 57:02
• Paula tells about her plans for the business going forward 1:02:11
• Paula recommends some action steps for people to take 1:04:27

Membership Changes - Join Now!

Before you go, I just wanted to remind you that we are making some big changes at the moment to Psychology Business School and the Do More Than Therapy Membership. Don't worry, all the changes are very positive, and we're going to be bringing you more value, more content, more templates, pretty much more of everything! But just to let you know, this is the best time to join. If you've been on the fence about coming and joining us in Psychology Business School, our complete course and suite of legal documents for getting you set up in private practice, or if you've been thinking about joining us in the Do More Than Therapy membership, our monthly membership which helps you to grow and diversify your practice by getting outside of therapy room, including our complete roadmap to a successful online course, if you've been thinking about either of those things, now is the best time to join because you will get the best price and you're still going to get everything that comes with the changes that are coming in the next few weeks. So if you're on the fence at all, jump off the fence and jump in and join us. We're over at psychologybusinessschool.com Do come and take a look. I look forward to seeing you there.

SPEAKERS

Rosie Gilderthorp, Paula Redmond

Welcome to the Business of Psychology podcast, the show that helps you to reach more people, help more people and build the life you want to live by doing more than therapy.

Hello, and welcome to today's episode of the Business of Psychology. Today, I'm really happy to be back after my break and talking to the wonderful Dr Paula Redmond. Paula is a clinical psychologist who specialises in burnout. So this is a very pertinent topic for me right now, as those of you who've been long term listeners will know, I recently took a bit of a break from the podcast and from my social media profiles, because I managed to burn myself out, even though I wasn't seeing any clients! Which I hadn't previously thought was possible, but it very much was. So Paula's content has always been very supportive to me; she's an extremely helpful and knowledgeable psychologist. I've also known Paula for a couple of years because she's a member of my membership, and we've done some coaching together. But I've been desperate to have her on the podcast for ages to talk to us about this subject, because I know burnout is a big problem in private practice. It doesn't end if we leave the NHS does it? So a big welcome. Welcome, Paula.

Thank you. Thank you for having me.

Oh, it's wonderful to have you here. So I feel like I've done a little bit of an introduction there, but it would be really great for people to get to know you a bit better, so can you just tell us who you are and who you help?

Sure. So I am Paula Redmond. I'm a clinical psychologist, and I work, my background was in older adult mental health for a long time. But just around two years ago, so kind of 2020, I left the NHS and set up in independent practice, and I specialise in working with health professionals around burnout and workplace trauma. Yeah.

So it feels like you've had quite a short journey really into private practice, 2020 feels like yesterday to me. I don't know if that's with the effect of the pandemic, but you've achieved a lot in a short period of time. And it certainly... kind of knowing you a bit during that period, it's felt like you were fueled by a real passion for your subject. So let's talk a bit about that, and where that passion comes from. So firstly, what is burnout? Because I know we hear it all the time, but what does it really mean?

Well. It's such a good question, because I think it is a word that is used a lot right now, and I think, I think it's important to understand it clearly so that we can be effective in responding to it. So the WHO, the World Health Organisation, is very clear that burnout is not a medical or mental health condition. And they describe it as an organisational occupational issue. So it's, this is the definition, is that it's a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. So the onus is very much on the workplace and holding the responsibility for creating the conditions under which burnout can occur. And there's three dimensions; so feelings of exhaustion and depletion, getting feeling increasingly cut off from work, which can look like you're feeling very negative or or cynical, or just very detached, and a reduced sense of professional efficacy, which is, you know, often shows up or self doubt, just feeling like, you know, we're no good at what we're doing and kind of yeah, stuck. So burnout, kind of technically, according to that definition occurs when we experience all three of those, and there's lots of overlap, but we might find ourselves identifying more with one of those areas than another. And I think particularly for health professionals, and I guess, especially thinking about what we've been through in the last few years, I also think it's important to consider when we say burnout, whether we're actually talking about trauma, and moral injury. So, one of the things I have put together as a burnout toolkit for health professionals, and it kind of breaks it down to these five categories. And as I said, you know, people might identify across them, but I think it's really helpful to tune into what might be going on for you, or might be most salient for you at any particular time. So those patterns which kind of match to those definitions are overloaded, detached, self-doubting, and then as I said, the kind of traumatised, and morally distressed bits, which I think are really important.

I think that's really helpful, because I think, like with any label, people do tend to get a bit concerned that maybe they don't deserve the label, or they're either worried that they're too far down the line or that they're not, yeah, not somehow deserving of it. That, you know, my job is not hard enough, I shouldn't be feeling like this. You know, it's always the shoulds and the shouldn'ts, isn't it that kind of get us in our heads and stop people from getting support?But I think what I like about what you just said, is that sometimes people might be able to identify with one or two of those areas, and then find a practical way forward from there, rather than having to be like, should I be labelled with this syndrome as a whole?

Yeah. And I guess people who, when we talk about burnout, if you don't recognise yourself in what's being described, or what you've seen, you might think, oh, I can't be burnt out, because I'm experienced, like, I just don't care anymore. I don't give a shit. Am I allowed to swear?

Yeah yeah yeah, I always have my podcast as explicit.

Yeah, you know, I just don't give a shit anymore. Whereas other people might be, you know, staying up all night worrying about work, and you know, can't stop caring. And those two things, you know, can feel like polar opposites, but I guess they could both be called burnout.

That's so interesting. They're kind of coming from the same place, if they might look and feel really different.

Yes, yes. Yes. And I guess there's, you know, that there's something that in all of, what holds it together is a kind of just struggle to function. And then it becomes, you know, can have a snowballing effect. Because if you're not gaining meaning, and satisfaction from work, you know, that's just torturous. You know, and if you're continually just exhausted, you know, we spend so much time and energy, and I think, again, especially for health professionals, identities are so caught up with work that if we're not functioning at work, it has huge implications for us emotionally, psychologically, and for our mental health. So I think, you know, again, there's overlap with, you know, anxiety and depression and all of those things that it can start to develop into because work is so important to us.

Absolutely. And I think it's interesting what you said there about the WHO definition, very firmly putting the onus on the workplace, and then the workplace creates burnout, it's not located within the individual. I thought that was really interesting. You know, what, I think I'm almost laughing asking the question, because I feel like a lot of people listening will have a list as long as their arms of like, what toxic stuff has gone on in their workplace. But what are some examples of situations that might occur in the workplace that would be likely to lead to burnout?

Yeah, well, I think the big one is workload, you know, just unrealistic expectations and pressure to achieve, you know, crazy targets without adequate resources, so that gap between demand and resource. And I think often what we find, you know, particularly in healthcare, particularly in the NHS, is a kind of... just a lack of acknowledgement about that. Like, there's so much creep, that you almost can't say that, you know, there's no way to say like, this is crazy, this is nonsense, like it's not doable. You know, it's kind of normalised. So there's, you know, and I don't want to use this term, because I think it can be overused, but, you know, there is a gaslighting that goes on, you know, like, just, you know, you just can get more demands into your inbox, or now we've just added an extra bit to the form that you have to fill in. And it's like, no we couldn't even do it before, now you're just adding on and it's death by a thousand cuts some times, just adding, adding, adding, and stripping, stripping, stripping of resources. So I think that is, you know, a key one. I think the other thing that's really important is the kind of dehumanising culture that can go on where people really feel like they are a nameless cog in this big machine and their individual needs and rights are not respected. So that can come down to things like, you know, knowing your rota patterns long enough in advance, so you can plan your life or, you know, having your annual leave respected or approved, or being able to take a lunch break, being able to have a drink, you know, we've seen in the last, you know, recently when it's been very hot, you know, the, like nursing bodies having to put out messages to say it's okay for nurses to have a drink of water on their shift. Like what is that? I mean the fact that even has to be said is crazy. You know, just not being able to access hot water or rest or, I mean, hot meals, you know, or rest, or those kinds of basic things can really grind you down and mean that you start losing a connection with, with work or just being able to maintain your own health. But I think that there's also an aspect where you're not able to deliver the care that you want to, whether that's because there's not enough resource because you aren't resourced as a human being enough to do that, and how distressing that is, to day after day, you know, be giving not good enough care or feel like you're not giving good enough care, when you're giving everything. It's really hard.

And I guess that can come down to what's the next person that I'm handing over to in the chain? And if that person is cut, or you know, they're under-resourced in a way. Even if your individual bit might have been seen to be ring fenced, it can be really traumatic, the handover to the next stage for somebody and know that it doesn't really exist. I can definitely relate to that, that's my previous NHS experience.

Yeah, yes. And I guess if we're talking specifically about psychology and mental health therapies, the sense of, you know, people haven't been on long waiting lists, you know, desperate situations, and then you've only got six sessions. And then, what? It's just a horrendous position to be in. And as if successions, you know, and there are some times when, you know, brief work is, is okay, but if you've been waiting two years for that? And, ah, that's, that's rough to have to, you know, hold that every day and not have a desk, or a functioning IT system, all of those kinds of little niggles. So it can really weigh on us very heavily. And I think, you know, often it is these kind of, you know, sometimes we might have a major event that happens. So, you know, something quite traumatic, whether that is something that might happen clinically with a client, something that happens with colleagues, you know, bullying, for example, that's a huge contributing factor, or kind of just hostility with colleagues. But often we kind of cope with that and we manage that, but it can, often I see it to the smaller things that kind of break the camel's back. Which I think is a very common thing, that when people look back and pinpoint the moment they thought, I can't actually continue, it's something very small, like, you know, the computer crashed or...

Couldn't get a parking space.

You couldn't get a parking space, or you know, you (I'm speaking of myself here), you know, did something that compromised you like taking your sick kids to nursery when you kind of really knew they shouldn't go, but you just felt you couldn't miss work. And then you go and like, you know, someone else has taken your room booking or you know something's been cancelled and you find yourself having compromised your values one time too many.

Something about that thanklessness, and it's, you know, I think you called it dehumanisation. But I think it is that basic lack of respect, isn't it? And it's how am I supposed to deliver a good service to people when I'm not deemed worth having a desk? I'm expected to work in my car, so how can I be what these people need me to be? And I remember having a strong sense of that, that families had waited a long time and then they were presented with me, and I felt like a piece of dirt, because that's kind of how we were treated. So there's lots of issues in there. And I think I've always got an ear on, so how are we creating this or possibly recreating this in private practice? A lot of people listening to this will have had that realisation that they were burnt out, and decided to make a big change, whether that is stepping entirely into independent work, or whether that is stepping down a little bit from their NHS posts, and taking on some independent work. And what I've noticed from people in our community, and that I've talked to, and in myself, is that often we kind of recreate this burnout. And there are two things that really struck me, the gap between expectation and resource and the dehumanisation, and how easily we can actually do that to ourselves. Just thinking about my recent experience, the thing that burnt me out was expecting myself with a very small baby, and two children under five, and my husband not being around, to still be pumping out a podcast every week, social media to promote that podcast every week, plus doing all the other stuff I have to do to run the business. And I didn't even really notice that that was an unfair expectation, because I guess we kind of get used to it. And I think there's a real danger of that. And it's the same with the dehumanisation, if you've not had a lunch break for your whole career, it's probably a lot easier to say, oh, yeah, I'll just squeeze that client in and compromise yourself. And even things like you know, you've not had a water cooler for the last decade, so you don't do little nice kindnesses yourself, like putting some water in the fridge.

Yes, yeah. Yeah, it's really easy. Yes. And it's, and I see it in myself too, and then it becomes very challenging, because we don't have the big ogre of the organisation to locate the responsibility, and we've got to be accountable for that ourselves and acknowledge how entrenched those patterns of relating to work have become. And exactly just the kinds of, you know, things you've mentioned about how we can, you know, treat ourselves, you know, really badly around working conditions, not taking lunch breaks, compromising on on, you know, the things that, as you said, are usually the reasons we decided to make a move, which is never an easy move. You know, it's always really tied up with, you know, guilt, I think, for most people, you know, it's a tough decision to leave the NHS, especially if you're doing that completely, and it's not one that's taken lightly. And it is so interesting how we can, as you say, recreate those patterns and the very things that we, you know, led us to make those decisions, we kind of bring them with us. So, some of the things you know, I've noticed one of the things I really struggled with, working in older adults, which particularly for psychology, historically, really underfunded, and I was usually for most of my career, the only psychologist or we only had one post, you know, for a huge patch and was doing a job share. Which meant that, you know, if you if you lived in that, you know, big geographical area and you needed a psychologist, whether that was for, you know, OCD, or psychosis, or couples therapy, or dementia assessment, or, you know, depression, anxiety, whatever it was me. And I couldn't say, oh, no, like, I'm not really that's, you know, I don't really have the right expertise, I couldn't say no, I had to say yes to everyone. And that... I hated that. I hated not having an opportunity to really develop my interest expertise, because I had to remain a generalist. But that also meant feeling like I couldn't really offer anybody a really excellent service. And then in private practice, you know, sometimes I found myself doing that, you know, feeling like I can't say no. Y'know, maybe partly a kind of moral obligation, it's hard to say no, anyway, it's hard to say no if someone's sought you out. But then there's also a financial, you know, concern that is different and new. And there are times when, you know, I found myself feeling very similarly, like, oh, my gosh, how am I meant to serve people with all these different needs? And why have I done this to myself again? So I think being able to, to notice that and have support to notice those patterns, is really key. You know, and other things like becoming, you know, professionally isolated, which is a danger in the NHS, you know, you can have, you know, I worked as part of teams, which were lovely, but as I said, often the only psychologist and then, you know, working in private practice on my own at home, that's a big danger, and you've got to work hard, I think to counteract that, because it can feel comfortable. It's what you know.

Yeah that's really interesting. So that sort of brings me on to what my next question was going to be, which is about, you've mentioned the five profiles of burnout, and that it's really helpful for us to learn which areas relate most to us. But what do we kind of do with that information? So firstly, maybe you could say a little bit about what the five profiles are? Because I know a lot of people won't have heard of that. I hadn't heard of it before. And then we could think about maybe some practical solutions we could take if we're in that independent practice.

Yeah. Yes, well, let me... so let's go through the five then. So if we start with the overloaded pattern, which I guess is usually related to emotional exhaustion, or, you know, general exhaustion, and just that sense of drowning, you know, feeling like you can't really recover on your days off, you know, a weekend isn't long enough. You know, never feeling like there's enough hours in the day, you know, not leaving work on time, working evenings, etc. The kind of core task in responding to that is of being able to balance your needs, and rights with those of your patients. So I think there it's about kind of breaking it down to basics, about what you need to be able to function as a human in a human body. You know, and I guess that is around boundaries. Very much. It might be asking for help. It might be, you know, stopping kind of papering over the cracks, you know, letting things go so that, you know, the reality can show up. And it might also be a chance just to think about your processes, you know, can things be done differently? Allowing yourself to take time out to look at that, you know, if you're so in the work, it's hard to step back and look at how things could be done differently. And I guess in private practice, that might be about outsourcing some stuff.

Give yourself permission to even think about it. I do hear a lot from people who are kind of in that burnt out place, that they don't have time to do anything other than client work and basic governance. But if you did take 20 minutes even think about how you're doing your intake form, you might then gain a lot of time back. But it can be really hard in that mindset, can't it, to make that shift. So officially, we're both giving you permission to do that.

Yeah, absolutely. So looking at processes. So the next pattern is the detached pattern. So that's about really, you know, kind of not caring, not feeling like you care, or just like, I'm sure you can think about those people, particularly if you've worked in the NHS, who just are really cynical, sarcastic all the time, like, you know, they're just there, or it feels like they're just there, you know, because it pays the bills and, you know, working till they retire kind of thing. And there's nothing wrong with that, you know, that's, but I guess, if you're curious about burnout, you know, you're feeling that gap between how you want your life to be and how it is, you know, there's, there's some pain in there. And, you know, that's about, I think, feeling just a lack of fulfilment, and a lack of connection with work. So the core task, when we're in that space, is trying to maintain a compassionate connection with our clients, with our patients, meaning in our work, while at the same time protecting ourselves, so we don't want to go too far, because often that detachment is a protective response to being overly attached to work. So, you know, it's all about finding that balance. And I think, you know, there it might be about, you know, making a change at work, you know, just thinking, do you need to do something very different? Do you need to see different client groups? Do you need to step away from direct clinical work for a time? Do you need to, like foster identities outside of work, find meaning elsewhere for a time? Actually take a work break, a sabbatical? And also, I think, connecting with colleagues, so maybe the focus there can be on fostering relationships with colleagues and rebuilding meaning in that way. So yeah, that for me would be what I would pick out around the detached pattern.

Yeah, I find that one really interesting because it's the hardest one to own up to. I think people find it really difficult to say, actually, I am feeling a bit detached and I'm not, I'm not feeling as much passion for helping people as I used to. But I think we know it when we experience it, and it's easy to see in other people, but harder to admit to yourself.

Yes. And for me that this was where I found myself and one of the reasons I initially decided to step away from NHS work was because I was bored. I felt like I could do it in my sleep, I kind of like, was, didn't, not that I didn't care about individual patients so much, but I kind of, yeah, I sort of wasn't excited, I was bored. And I just knew I needed something very different, because I didn't like it, like that felt really uncomfortable and sad, and not how I wanted it to be. But yeah, that's a really hard thing to say about this line of work.

It is. And I think, you know, for me, I recognise it as well as I normally have, to like when I'm feeling good, I have an excitement about work, whatever I'm doing, I tend to wake up in the morning and feel quite excited about doing it. I know that makes me quite fortunate most of the time. But when that spark goes, I almost can't function really. I just, I can't drag myself through whatever I'm doing, whether it's client work or stuff I'd normally find, you know, less stressful, like writing up notes, report writing, and anything really, it just... everything feels like dragging myself through treacle. And for me, it has been that I need a total reset. I'd like to think that maybe if I use your toolkit, and I listen to your podcast, and I follow all your advice in the future, that I might notice it before it gets to that point, and I'd like to talk about that kind of prevention strategies, as well, but I feel like I've never been that good at spotting it until it's got to the point where it's like, actually, I can't do this, total break required.

Because I think, I think again, that's that's the culture that there isn't space for those kinds of conversations. And I honestly think that, you know, we have a massive recruitment and retention crisis in the NHS right now. And I honestly think, if things like just recognising that as humans, we can't just keep going and going and going and going, like, it's normal for people to take breaks, it's normal for people to need a rest, it's really important. And if that was built into our working lives, I think it would be transformative, you know, if people had a month sabbatical every three years, I just think it would be amazing, you know, people would, you know, because it's also times for for growth and creativity and expansion, that we would be able to just offer so much more. And I think it's, you know, to say, I can't be arsed with this anymore, like, I need to do something else with my life. I mean, you know, what a scandalous thing to imagine saying. But it's, it's, like, that's just normal, that's, you know, how we are as humans, like things have seasons. And I think, I think and that's why it becomes so problematic that we can't say it when it's at that, oh, God, like, I just need a bit of a break right now. We have to hold on hold and keep going and keep going until we can't get out of bed. Or something horrible happens.

Yeah. And it's, it's that combination, isn't it? It's like, there needs to be more rest built in. I think we can see that. But actually, on its own, that wouldn't fix the problem, because the dehumanising practices are still going on. Whether that's, you know, in our independent practices, or in the NHS context, it's like, we have to keep our eyes on all of these factors. And that's what it feels like. It's difficult enough running a micro business like mine, to think about how to do that, let alone with a big organisation. And I think that might be partly where the challenge comes, because we do every now and again, see initiatives that are designed to improve wellbeing, but they usually target one of these areas, and then we will just get angry that they're focusing on that and ignoring all the rest.

Yes, yes. Yes. Yes. And I think there's lots of problematic stuff around those well being movements. And I think, I think it's because of the relationship that we have with work that we don't become very cynical about the organisation, you know, offering us, you know, yoga classes or, you know, some shiny thing with one hand, when they're actually beating you up with the other hand, and you know, those basic, you know, if we could just be consistent with the basics. We don't need the shiny things, we don't come to do this work for the shiny stuff, we come you know, because we care about the everyday.

Gosh, that's an interesting dynamic, actually, with a lot of public sector organisations. It's just sprung into my head, it's probably a bit of an overshare, but, but as Armed Forces spouses, we fill out a survey every couple of years about, you know, how the Armed Forces is treating us, basically. It's called, like, the friends and family survey, something like that. And I filled mine out last year, and I put stop sending the stuff toys and start treating me like a human. And I wrote it over and over and over again. Because it was exactly that feeling, though. I was like, great, you've organised a fun day trip for my kids, and actually, I am appreciative of that because that has value in it. But you can't do that at the same time as giving my spouse short notice moves up and down the country that are totally unsustainable for a young family. And it feels like that doesn't they're like, okay, you can have a yoga session in your lunch hour, but we're also going to take away your social workers. Yeah, gosh, I hadn't really thought about that, but there seems to be a common dynamic across perhaps the public sector, but perhaps actually big organisations in general. I don't know so much about that.

And I think, you know, we can. It's important to sort of think, I don't know if politically is the right word, but I feel like those gestures often act to silence us. You know, just recently the NHS was given a medal by the Queen. Like, what is that? You know, when at the same time, there's real cuts in pay, you know, real term cuts in pay, but literally a shiny medal. That makes, that makes people angry. And really erodes trust. And so then when something does come along that actually might be very helpful, evidence based, you know, mindfulness stuff, people can't take that in, because so much damage has been done.

And perhaps that's the part of burnout which doesn't get recognised as much as it needs to be. Because actually, anger is the emotion that we have the most trouble recognising in general. I think as a society, and that's if people were more willing to name the anger rather than just calling it stress, perhaps more productive stuff would be done.

Yes. And I think that's why I always find myself in a funny position because while we very much, well I very much think about burnout as being a failure of the organisation, actually, it's hard for the repair to be done by the organisation, because our relationships are so damaged. So actually, we need to be able to offer ourselves that. So you know, and we need to learn how to relate differently to ourselves, in order to give ourselves permission to take what we need. So for me, I think that's where I kind of square the circle of this is an organisational systemic problem, but individual interventions are necessary to help people recover and respond and empower people to name what's going on.

Yes, I think that's really important. So would you recommend that people first sort of work out what their profile is against those five? Did we cover all five?

No, I think we only got to two.

Oh, my gosh, sorry, it's because I interrupted. All right. So remind me, remind me what the first two were?

So overloaded and detached, and then the third one is self doubting. So that is kind of basically, you know, feeling like nothing you do really makes a difference, you know, anxious about, you know, what you can contribute. And I guess just to summarise what I would say around that, you know, most of us going into these kinds of jobs are selected for our perfectionism. So, you know, there's a constant battle there. So I think it's about finding a way to strive for excellence, because that is important to us, it's important to our patients, while also having compassion for ourselves, when we make a mistake, don't have all the answers, don't have the resources. So again, striking that balance. And that's often about, you know, kind of being able to maintain a really realistic stance about what is achievable given the resources that you have. And, you know, just some of the stuff around working with perfectionism in terms of, you know, can we think about progress rather than perfection? And cultivating self compassion?

And you have done some really helpful podcast interviews around those topics. So make sure, if you're listening to this and you're thinking, oh, yes, I relate, listen to the When Work Hurts podcast, that's Paula's podcast. And yes, just so many useful insights from lots of experts, but also from yourself, Paula.

Oh, thank you. So the fourth profile is kind of traumatised profile. So, you know, we might think that we would be more familiar with that, but I think we're not great at recognising that within ourselves. And so that kind of, you know, covers the spectrum of vicarious and secondary trauma, but actually direct trauma that we can suffer in relation to work, whether... I work with a lot of people who have been bullied at work and who, you know, really have a post traumatic response to those experiences. But it's also maybe about what we've witnessed, you know, particularly through the pandemic, for example, but also just in the nature of mental health work. And I guess, you know, the task there is finding ways of helping our mind and body to process what we've been through. And I think for us, that can be hard to, to acknowledge, to allow ourselves to receive the care that we need as mental health professionals. But, you know, I think all the things that we would be supporting our clients to do in terms of, you know, seeking help, being able to tell our story, but also kind of embodied stuff around you know, grounding movement, creative expression, are really important. And so then the final one is about moral distress, which I think again, you know, relates to a lot of the things that we've experienced in the last couple of years, but I think has been around for a long time in terms of, you know, really being witnessed to practices and, you know, service stuff that we feel is wrong and being made to be complicit in delivering that. So, there it's about being able to kind of make room for the pain of that, the reality of that, without getting stuck into kind of self sabotaging or punishing behaviours, you know, without getting stuck into withdrawing, you know, self blame, self criticism, and shutting down and finding ways of, of opening up to our own responses, finding ways to take valued action motivated by that moral pain. Yeah.

That sounds really powerful, because for both of those final two, the traumatised presentation and the moral injury, I think people often don't allow themselves those categories. Because it's so difficult, I think particularly for psychologists and therapists, who are hearing a lot of stories, often our clients come to us with stories that are thankfully well beyond our experiences. You know, it often happens to me that I will hear something in the therapy room that I just think my world has been so much more protected than yours. And it's so, it's humbling in a, in a good way, in some ways, but it also means that you start to think well, what right have I gotten to be, you know, traumatised by this thing that I didn't even happen to me? I just vicariously experienced it. And I think I hear that a lot. And even from people who, you know, you and I might think, of course, you're traumatised, like I was talking to an ICU doctor about it, and they were like, well, what if I got to be traumatised? I could breathe, I wasn't living it. You think oh, my gosh, but to me you were, just in a different way. And I wonder if that happens at every level, people just not giving themselves permission to say yes, I am traumatised.

And again, I think it's reinforced by our working culture, you know, if there's an idea that you can spend, I don't know, 20-30 hours a week, sitting in a room with a traumatised person every week, you know, what, 48 weeks a year? You know, that that gives you the message that, you know, you should, that should be fine, that should be normal, that, you know, there's nothing wrong with that. But actually, wow, that's a lot, you know. And yeah, you know, if we are there and present with our clients, that's going to be a lot. And too often if we're not careful.

So if the first step is recognising some of this stuff in ourselves and working out our profiles, what do we do? How do we take it forward from there? What's the practical stuff we can do?

Yeah. So for me, there's kind of three threads that run through my work around this, which are compassion, connection, and creativity. So I think we need to start from a place of compassion, and I define or the definition of compassion that I draw on is that from compassion focused therapy, which says that compassion is the sensitivity to the suffering of self and others, and a commitment to alleviate that. So we start with the sensitivity to the suffering. And that's difficult. That's something that needs you know, cultivation because actually, we are bad at that. Particularly health professionals, I think particularly mental health professionals, we can be very good at being sensitive to other people's suffering, but actually, we're not great. So being able to cultivate, you know, a sense in the moment, what is it that I need right now? Like, you know, is it an ice cream, or is it a walk, or is it to call someone, or you know, is it a hug? What is it that I need right now? In that kind of micro level, and then thinking more macro? Like, what is it that I need in my work right now? Do I need more variety? Do I need more support? Do I need less of something, more of something? And being sensitive, I guess to, you know, what kind of profile it is that is showing up for you can help us be more directive? Do I need more connection? Do I need more rest? Do I need more processing space? And then taking action, you know, to respond to that. And for me, that often looks like connection. So by that I mean, a variety of things. So connecting to our values, taking time to you know, and that's part of what we were thinking about, you know, why are you doing this? Why are you making the choices that you've made? Sometimes we need a reminder of the reasons, you know, if it was to spend more time with your family, are you doing that? You know, is the way you're working, allowing you to be more present with them or, or you kind of getting hooked by other things? Connection with values, connection with people, and I think, you know, with community and particularly, I guess, if we're thinking about private practice, that can be really challenging, but, you know, finding a way of building a community, whether that's online, or, you know, locally to you, I think is really key and something like, you know, the Do More Than Therapy community, personally has been brilliant for me and in helping to shake that. And then I think, you know, connection to our bodies, to nature, that's very easy to forget, especially when we are working online, as a lot of us are.

Yeah, and it feeds, one feeds into the other, doesn't it? Because if you're not allowing yourself to be sensitive to what you need, you might not notice that your body needs to move.

Yes, exactly. Yeah.

And so then, of course, you don't make the space for you to have that. And it's the same with the support. One of the reasons that I set up demoulding therapy was because I suddenly had this light bulb went off in my head, that I was sad, because I had no connection with other psychologists and I really missed it. But that must have been true for years before I took that step. And I just was insensitive, I suppose to my own suffering. And I think that's partly what we were saying about the dehumanisation aspect if you've been used to being treated in that way, actually switching yourself back into treating yourself in the way that you would treat a client and showing that compassion yourself, that's really hard, it's a big ask.

And I think reminding yourself that you have choices. You know, I think I've certainly found myself just reenacting a lot of patterns, like, you know, working three long days, for example, because that's how I always, you know, well, since I started having kids how I always did it, and that meant, like, you know, from nine to five, absolutely, like packing it in. Which I found that, you know, by the end of the third day, I'm like a dead person. I've just... so actually, it takes me two days to recover, so I'm not there for my family, because I'm like a zombie. And being so actually, maybe, like, I literally don't have... what am I doing? I make the rules. So I'm planning, you know, to shift things around. So actually, I'm going to work mornings, four mornings, rather than three long days, to do all my client work in the morning, because I'm better in the morning. It's better for me, it's better for my clients. And just keep reminding myself that, you know, I'm making the rules,

I think that is absolutely key to it. I think if you take one thing from this podcast, and you're feeling a bit burnt out in independent practice, it is that you make the rules. So we have this opportunity to create a business that doesn't burn us out. But we need to have that sensitivity really, so that we can give ourselves permission to do it. Because often when you say to somebody, what would be your ideal working pattern? They do know, they've just never ever thought that they could choose to work like that.

Absolutely. One of the things that I have also, has been really important to me. So I've mentioned earlier that I, you know, in my NHS job, I felt, you know, this kind of jack of all trades, kind of clinical psychology, generic thing, I really struggled with that. And so part of, you know, developing a really clear niche. You know, I know, you talk a lot about that, and it's very sensible from a business point of view. But I think from my point of view, it's made a lot of sense, in responding to that need to feel confident about what I can offer, to be able to build expertise, to seek out the support that I need. And one thing I don't scrimp on, is supervision. And it feels like such a great luxury to be able to seek out the specialist supervision, as and when I need it. And I never feel bad about that. It's a really important investment for me. And it's a, you know, fairly big expense, but I'm not willing to compromise on that because, as you know, whether, whether that's kind of part of me, at the early stages of my journey into private practice, really counteracting a kind of sense of deprivation, from before, but right now, for me, that is an important way of meeting my needs in this work.

I think it is really important and generally who you surround yourself with, I think really matters. Because you might find that you have a supervisor that is really helpful to you in some ways about some things but actually isn't quite ticking your boxes on other things. And it's okay to then go and find someone else in addition, or instead of. Because I think it took me a long time to recognise I could make that choice. And I had a supervisor who was lovely, and so helpful to me in the early stages of my practice, that she used to be very proud of the fact that she saw seven trauma clients every single day. And actually, I realised that being around that was really fueling a lot of my own difficulty, and causing me to make decisions that weren't in my best interest. Because, you know, that was okay for her, perhaps. But it wasn't, that's not a way that I can work. And so actually, I have to choose to end that relationship and find different supervisors, and I now have several, because I think similar to yourself, I want to nurture myself with all of that expertise and support.

Yeah, yeah. Yes. So that is kind of a compassion and connection bit. And then for me, creativity is really important. And I think about that on two levels. One is, I do believe that kind of having a creative practice is really good for us, whatever that looks like, whether that's, you know, creative writing, or music or dance. For me, it falls into the kind of arts and crafts realm, and it's something that really sustains me personally. So I think there's that part in terms of having a way of kind of buffering stress and processing what we go through, and I think a creative practice is really key in that. But I also think it's about creativity in relation to our work in terms of growth and development. And again, as a kind of antidote or response to the pain that we deal with in our work and these kind of dehumanising systems, being able to do work that is creative, I think is a huge antidote to burnout, and is a thing that I think it's very crushing in an organisation like the NHS where, you know, innovation is virtually impossible. It has to go through however many millions of committees, and, you know, there's no funding and whatever. And I guess, you know, that can look like lots of different things. It can look like doing training, it can look like just exploring interests, you know, it could be a podcast, social media stuff. I think that's really important, and it doesn't have to, you know, cost a lot of money or cost a lot of time, but I would I do encourage everybody to, to invest something in a creative pursuit or creative part of their work to sustain them in, in what we do.

Yeah, that's interesting, because we do have so much opportunity for creativity in private work. And I think, you know, a lot of the time when I've been writing a new website or thinking about a new project, I do feel that kind of creative ignition, because you can just try it. And it might not work but you've tried to do something creative, and you will learn from it as well, and something about that process kind of keeps you alive in your work, and I very much feel sustained by that myself. And there's often a lot of fear around it, and there's this fear of putting myself out there, whether it's doing something like that, which is a creative work project, or whether it's, you know, doing some knitting, which I know you know a lot about, or a craft project, I think people get scared to try stuff which they don't already know they're good at.

Yes, yes. And I guess that's where the other two parts come in, the connection and the compassion. You know, being able to be part of a community that feels safe, where people are doing similar things, and yeah, you know, cultivating self compassion skills to support you when things are hard. Yeah, so something like, you know, again, like you're Do More Than Therapy community, where people are all kind of struggling, and no one really knows, you know, what's going on, and you have your safe place to ask those silly questions, that can really then support your creativity and help with calming some of those anxieties and allowing you to pursue what, what you want to and what really kind of gives you joy and, as you said, that kind of spark of ignition.

So, I mean, that kind of brings me on to the interventions that you recommend for people, because I know that you work with some people one to one, but you've also got some other offers out there. Could you talk to us a bit about how you're working with people at the moment?

Yeah, so I mainly do one to one therapy, and some of that is kind of longer term, quite trauma focused work. So I'm EMDR trained, so I bring that a lot into the work. But I also do kind of shorter term work, and I draw particularly on Acceptance and Commitment Therapy and Compassion Focused Therapy. And, you know, sometimes people, I know, I often might see people just for three or four sessions, and it takes them more... I'm not, I'm not a coach, but it feels like it has a more kind of a coachy feel to it, because often people who come are really motivated and, you know, have have a level of, of psychological knowledge, that they're kind of good to go and need permission and kind of just a bit of support. But I also do reflective practice groups in organisations, which I really enjoy, that I guess that's part of my work mix, because I do that face to face, mostly and that's important, whereas my other work is online. So I like to have that mix and having a real kind of foot in the ground of, of what's actually happening, what it is like to be in an organisation is really important. But I'm also developing with a colleague, Mia Hobbs, we are putting on retreats that are developed around ACT and CFT ideas, but also with therapeutic knitting, which is Mia's thing, and really excited about that, because it kind of blends all of these aspects together, and there's an example of being able to do really creative work in this sphere. So, yeah, so that's called Creative Restoration, and, yeah, just a really exciting development.

And I'll make sure that there's a link to all of that in the show notes so that people can follow up and have a look. I think it's really exciting, I think it's great that you're offering that one to one support for the people that need it. And I think often we can forget that that work is really, really valuable when we get excited about developing a new creative project. Sometimes it can be tempting to be like, nuh, that's just my one to one therapy. But actually, what a wonderful thing to bring that kind of trauma informed work to the people that need it, as well as the kind of short term coaching stuff in such a tight specific area where they know that you're really invested in this topic of burnout, and that you're going to kind of have done all the CPD under the sun, I happen to know, about that area, and that you spend so much time thinking about them. I think that's really, really valuable.

And there's something about having a space where the kind of unspeakable can be said, because, you know, I don't have links to any, you know, organisations, there's lots of great, you know, mental health support out there for health professionals, which I always signpost people to, because it's free. But there's something about having an independent space where this stuff can be voiced that I think is important to... there's something about empowering about that for people. Yeah.

Yeah, it's so valuable. But you're also making this kind of big, sort of splash, I suppose by seeing people in a different format, where maybe people that don't feel yet like they need to come for one on one support, can learn to start cultivating that compassion in themselves and creating some sort of space for creativity in their lives. And I love the sound of, I love the sound of that. I kind of wish that I could knit.

We'll get you going, Rosie.

Yes, please. Yeah, cuz that a lot of us are quite inhibited about taking that first step in just doing something that might meet a creative need, and by targeting your retreats to specific groups of health professionals like that, it might just kind of open the door a crack for them to start trying, and I love, I love that idea.

Yes. Good. Thank you.

So what's your plan for the business going forward? Is there anything on the horizon or any ambitions that you can share for the future?

I think it's to kind of continue to explore this area of creativity a bit more, and to see how viable that is. You know, I think healthcare professionals are actually a tricky market, because we're not great at looking after ourselves. So you know, it's, it is challenging from that point of view. But yeah, that's kind of what I want to explore. And I think, right now, in this moment, as we're talking, there's something about a responsibility to my own needs, and shaping the work or, you know, my business around that. I feel like I, you know, have a very good sense of the clinical work that I want to do both in terms of being able to offer kind of, you know, real expertise in terms of across the spectrum of what people are experiencing. So people with a very significant clinical need, and also more at the other end of more kind of the kind of coaching type work, which I think ACT and CFT kind of really lend themselves well to. So just, yeah, just continuing to explore that, to maintain a variety of work that is sustainable for me too.

I think that's really important, and too often actually, when I ask people that question, there's all these thoughts about the whole world, and no thoughts at all about them. I think that would be ironic wouldn't it, with your specialty? So yeah, it's really good to hear you thinking about that, because of course it is sustaining you. It's gonna allow you to make that impact on the rest of the health professionals out there. So very good modelling Paula!

So I suppose you know, I always ask people what are the two action steps they would like people listening to this podcast to take would be. I'm going to throw one in there and say people need to go and listen to your podcast When Work Hurts. Listen to that people, even if you're not feeling burned out right now, it will help you sustain yourself going forward. It's a really nurturing podcast. I love it. But what other action steps would you recommend for people to take?

Well, I think... I think kind of having this idea of, of compassion, connection and creativity of mine would be really helpful. So, you know, just tuning in to what you need right now, thinking about connections that you need to build. Whether that is, you know, something really values driven, whether that's reaching out to people, whether that's something much more about connecting with your body, connecting with nature, and connecting with your creative side. So tuning in, and making a connection, I think with something that is about what you need, right now. And doing that as often as you can.

And would your burnout toolkit help me to work that out?

Oh, I should download that!

Because it's not that easy for a lot of us, is it to figure out what it is that we actually need?

Yeah, yeah. But I also think there's room for like, trying it out. Like, that's okay, too. Like, you know, I had this experience the other day, it was really super hot and I was flagging, and I was in the middle of the day, and I still had three clients to see. And I was like, oh my God, I don't know how I'm gonna get to this day. And part of me was like, have an ice cream, like have an ice cream. Like, you know, that's what, that's what you need. And then I was like, is it? Is that what I need? And I think before I would have been like, oh no ice cream bad, you know, it would make you fat, don't eat ice cream. But I was like, actually, I'm not sure. Like, it is actually what I need in this moment, I think what I need is to go for a walk and I can have ice cream later. And went for a walk, and that was what I needed. But I might have got that wrong and it might have been the ice cream that I needed, but I could still have the ice cream. So I think it's okay to get it wrong, you know, it's okay. Because that's how you'll know. You know, if you, if you try to do something and it doesn't, isn't quite the thing. And I think there's some, you know, with maybe with practice, I find that there are some go-to things that will never make me feel worse, that will always support me, which will be going for a walk, calling my mum, and knitting. Like, those are my things. So if I actually don't know what it is, I'll try one or all of those things. And, you know, maybe just having a think for yourself, you know, in those moments where you don't know what it is, are there some go to things that definitely won't make you feel worse, but might help you to tune in a little deeper.

I love that. Often I think what you need sometimes is just a pattern interrupt. You just need to do something that is a bit different to what you're doing right now, and then it might emerge what the actual problem is. Because I know sometimes when I'm feeling a bit stressed, I'll just feel icky. I've got no better words for it, I'm just sat there at my desk, perhaps I'm aware of a bit of the self doubt stuff coming in more than usual, I mean, it's always there, isn't it? But you know, if it's a day where I'm like, I literally can't face seeing that client because I feel like such an impostor, then I'm like, hmm, there's something going on here. But I'm rubbish, often I will have no idea what it is or what the real problem is, or how I should go about fixing it. But I love that idea of you know, just do something, and don't worry that it's not going to be the perfect thing, and the right thing might come to you. I think that's a really lovely message and a nice one to end on. So thank you so much Paula, it's been a really valuable episode. I'm gonna put all of your links in the show notes, because I think everybody needs to tune into your podcast, and download your free resources and just start tuning into their own mental well being a bit more in this work. So thank you so much for everything that you do to help us to do that.

Thank you, Rosie.

Thank you for listening to this week's episode of the Business of Psychology podcast. If you share my passion for doing more than therapy, then make sure you come over and join my free Do More Than Therapy Facebook community, where you can work on getting your big ideas off the ground with like minded psychologists and therapists. I'd also love it if you could leave this show a five star review wherever you listen to your podcasts. It will help more of the people who need it to find it. See you next week for more tips and inspirational stories to help you do more than therapy.