Autistic Burnout with Dr Alice Nicholls

Hello and welcome to the Business of Psychology. Today I'm really excited to be here with Dr Alice Nicholls. She's a clinical psychologist specialising in recovery from autistic burnout. This series of the Business of Psychology is all about finding fulfilment in your work, particularly as an independent mental health professional, and I can't think of a better guest than Alice, because the passion for what she does really shines through her website so wonderfully. I want everybody listening to go and have a look at her website as an example of how to do it well.

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

Links for Alice:

Website: www.dralicenicholls.com

Rosie on Instagram:

@rosiegilderthorp

@thepregnancypsychologist

The highlights

• Alice tells us about who she is and who she helps 00:48 
• Alice talks about the challenges in the early part of her career 01:46
• Alice talks about starting in private practice and her autism diagnosis 15:00
• Alice talks about the success of her blog and starting a membership 27:42
• I ask Alice is she thinks we are getting better at understanding and treating autistic people 40:57

Thank you so much for listening to the Business of Psychology podcast. I'd really appreciate it if you could take the time to subscribe, rate and review the show. It helps more mental health professionals just like you to find us, and it also means a lot to me personally when I read the reviews. Thank you in advance and we'll see you next week for another episode of practical strategy and inspiration to move your independent practice forward.

Psychology Business School: Start & Grow and Coaching

Is this the year that you take your private practice seriously? Maybe you are just starting out or perhaps you want to grow your practice with a team or passive income. Whatever stage you are at, I would love to support you. For new practices, I have our group coaching programme, Start and Grow where you will find all the support, resources and knowledge you need to create an impactful and rewarding practice. 

https://psychologybusinessschool.com/psychology-business-school/

For more established practices come and take a look at my coaching for growth packages. I have a couple of spots left for individual coaching so let me help you get 2024 off to the best start possible.

https://psychologybusinessschool.com/1-to-1-coaching-for-mental-health-professionals/

Mentioned in this episode:

Psychology Business School

Is this the year that you take your private practice seriously? Maybe you are just starting out or perhaps you want to grow your practice with a team or passive income. Whatever stage you are at, I would love to support you. For new practices, I have our group coaching programme, Start and Grow where you will find all the support, resources and knowledge you need to create an impactful and rewarding practice. https://psychologybusinessschool.com/psychology-business-school/ For more established practices come and take a look at my coaching for growth packages. I have a couple of spots left for individual coaching so let me help you get 2024 off to the best start possible. https://psychologybusinessschool.com/1-to-1-coaching-for-mental-health-professionals/

Start and Grow

TRANSCRIPT

SPEAKERS

Rosie Gilderthorp, Alice Nicholls

Hello and welcome to the Business of Psychology. Today I'm really excited to be here with Dr Alice Nicholls. She's a clinical psychologist specialising in recovery from autistic burnout. And this series of the Business of Psychology is all about finding fulfilment in your work, particularly as an independent mental health professional. And I honestly can't think of a better guest than you, Alice, because the passion for what you do really shines through your website so wonderfully. I want everybody listening to this, to go and have a look at that website as an example of how to do it well, I really, I think it's a brilliant website. And I don't want to take up airtime talking about you when I know that you could do it so much better. So can you just tell us a little bit about who you are and who you help?

Oh, thank you so much. And thank you for having me. I've listened to your podcast for so long and it's given me so much hope and confidence about, about what I'm doing in my business. So thank you. So yeah, I'm a clinical psychologist. I'm autistic. And I'm currently not seeing many clients one to one and I'm focusing more on a membership and an online course. And I've got a group coaching program coming next year as well.

That's really exciting. And I can't wait. I need to dive into all of that with you. But I'd actually really like to start by talking about some, some of those decisions you had to make when you're going into clinical psychology, because I imagine as an autistic person, it must've been you know, challenging at times. I think it's challenging for everybody going through the training and application process. So is it all right if we start by talking about that early part of your career?

Yeah, absolutely. So I didn't know I was autistic. But I knew I really struggled and I'd had some very significant mental health problems as a teenager. I'd been hospitalised and I didn't understand myself and I didn't understand other people. So I thought like psychology would be a good thing to study. And you know, I, I didn't do much. I didn't actually go to high school. I got three GCSEs because I didn't really go to school and I did A levels and then a degree and I got a first in my degree. And then I went. Yeah, there was there was a whole other bit where I tried to do an occupational therapy degree and it didn't work, didn't work out, and actually I'd been encouraged to do occupational therapy by my parents who thought there was a clearer career path at the end of it. So I'd been encouraged to do that. I'd gone to Coventry and I'd tried to really throw myself into the social aspect of being a student, and I'd had actually what I know now was a massive autistic burnout and ended up in hospital and then back home and didn't finish the occupational therapy degree. And actually when, as part of that recovery, I started to think, well, what would I do if I did what I really wanted to do, you know, rather than what I should do. And you know, I'd got, I got an A at psychology A level. I was interested in psychology, and I had that real want to understand myself and why I struggled so much, but also, you know, the people around me. So I went into, I went and did a degree, got a first. I said that was easy. It wasn't easy. You know, I, I got quite bent on getting the first and yeah, you know, my, the rest of my life kind of suffered as a result. And I was very determined to pursue psychology as a career because, partly because it was what I was very interested in, but also because my parents told me it wasn't a career. So I obviously had to prove them wrong. And so yeah, so I got a job, I'd done a lot of work with people with learning disabilities and autism, like voluntary and then as a carer, and those kind of capacities and I really liked that client grade, but I was aware for psychology I needed to get some mental health experience, so I went and worked for MIND for a year as an outreach worker, and then I got a job as a graduate mental health worker back when that was a thing. And I started to experience difficulty getting jobs because of my mental health history. So occupational health would flag me up and I'd have to get interviewed and they'd have to have letters from the last psychiatrist that saw me and all those sorts of things. And it made me become aware that I needed to stop having mental health problems publicly, or like on record. I think it made me aware that I needed to start hiding that part of myself.

Gosh, that's so sad. Just to, just to kind of touch on that a little bit. So you'd had these episodes, which had been diagnosed as mental health difficulties. And you felt you just needed to hide that, you didn't feel confident that that would stop happening, just that you would need to cover it up.

Yeah, yeah, no, exactly.

That's really, really difficult.

Not, oh, I'll find a way of getting better, but no I'll have to just hide that I'm struggling better.

So was there a part of you at that point that knew that you were getting the wrong therapies or the wrong treatments at that time?

I think I was quite fortunate in that I wasn't really given a diagnosis. I was diagnosed with depression and anxiety. And I think I'm fortunate I didn't end up with a diagnosis that might have been more restrictive.

Well, I was just really struck that it's, it's quite sad, but also very self-reflective to be like, look, they're not really helping me every, every time I try and get help, it doesn't really work. So pragmatically what I'm going to have to do is just, I suppose we might call it masking now, but just cover this up basically so that people aren't aware of it. And I thought pre diagnosis, what sense did you make of that?

I think the sense I had of that was that I just wasn't a good enough person, that I was in some way a faulty human being, and that I needed to hide that, that I needed to play, if I was going to get by in this world, I needed to play a role that looked the way it was meant to look, and, and I think, you know, I talk about shame a lot in my work with autistic people, but that's because it's very much, it was very much my experience is I felt deeply ashamed that I couldn't cope in the real world and that I seemed to find everything very difficult and that I had these periods of not being able to regulate my emotions. Yeah, so yeah, I, there was an awful lot of shame and yeah, being aware that it was going to stand in my way of actually living the life I decided I did want to live. I, you know, I decided I did want to do this thing. This thing was the thing I wanted to do. I wanted to be a psychologist. And the idea that my struggles were going to stand in the way of that, you know, was, was really it was really quite scary. Because again, being autistic, like I'd set my mind to this one thing and that was the one thing I needed to do. So yeah, I became aware I needed to hide, not, you know, I didn't lie, I didn't hide my history, but I became aware that I needed to not go and see the doctor with mental health problems. You know, I'd had various therapies that had been like of some help, but I think even in those I, I hadn't really felt well understood and I, I think people didn't understand why this young person from a, I guess an aspirational working class background you know, would be, with like you know, reasonable parents and without a massive trauma history, couldn't cope with life. Like people didn't understand. And there was lots of, I think my parents were told, oh, she'll probably just need to be on medication for her whole life. You know, I think they were told that when I was a teenager, and I never found the medication very helpful, I was put on lots of different medications. So yeah, so I started to, I started to kind of hide that aspect of myself and take on this role with this person I thought I needed to be if I was going to be a psychologist, I needed to be this person that had had everything together and looked the part. Yeah, I worked as a graduate mental health worker. And then I got on the Leicester course. So, I went for the, they had like a whole day of assessment. I went through all of that, and the computerised tests and I passed all of that and they offered me a place and then I got the occupational health form. And I thought, oh, that'll be okay. I'll fill it in. I'll obviously be honest. But then you know, they'll want, they'll want like, they'll want to talk to someone or to have a letter from a psychiatrist or something. And I wasn't, I wasn't seeing a psychiatrist. I was, I was away for, I wasn't taking any medication.

You know, I'd made, made it very clear that I was, I was fine. And the occupational health doctor phoned me and he said, oh, we're going to need the letter from the psychiatrist. You know, I'm very concerned about your history and whether or not you're right for this course, given your history. And I said, well, I'm not seeing a psychiatrist, I haven't seen a psychiatrist for years. He said, well, that's fine, we'll write to the last one that saw you. So they wrote to the last one who saw me, who said, yeah, she's fine, I discharged her. And he phoned me again, and he said, and I said, the letter was okay, wasn't it? And he said, yes. He said, but I would still like to strongly discourage you from doing this course. People with your history don't do well on this course.

Oh my goodness. I'm doing a very appalled face for people that are listening, not watching.

And I just said, can you stop me? And he said, no. And that was that then. So I was like, well, that's fine then.

Oh my goodness, Alice, you are, you are a hero. That's incredible. Wow. Where do you, where did you find the strength to do that? That really is remarkable.

I mean, being autistic, I just didn't have an alternative plan for my life. This was, this was all I was going to do.And that was, you know, this was the plan I'd made the plan. I was going to stick to the plan. And you know, these were, these were hurdles. I mean it was potentially, I did feel at that time it might have been a massive roadblock actually, and it nearly was, you know. But thankfully he couldn't stop me.

I just love that. And do you feel that that is an example of a strength of the, of the autism?

Well, yeah, I think we are very determined. Some people might call that rigid.

I think it completely depends on how it's serving you. And in that case, it served you pretty well. And it just really reminds me of my daughter. My daughter's autistic and she doesn't need anybody's approval to do what she wants to do. And I find it so refreshing. I love it. And yeah, that's, that's a really remarkable part of the story, I feel.

Thank you. So yeah, so I did, I did the doctorate, and I did struggle. I coped in not very healthy ways, but ways that were, that didn't flag me up anywhere particularly. And yeah, I struggled, I struggled through the three years. And continued to find a real affinity with people in learning disability services. So actually, I really got on with clients, clients that didn't talk in LD services, and autistic clients and, you know, without really understanding what that was. And I really liked working with people who weren't really able to understand what was, who weren't able to communicate what was going on for them and trying to help. To work out what it was, was going on for them. I really, I found that very powerful, a very powerful way of working, but also a way of working where I didn't like looking back, I didn't have to mask, I could go and show up as myself with these people. And so I was, when I qualified I looked for a job with, with that client group, with that client group who were engaging in behaviour that was difficult to understand and that people were very concerned about. And I'm aware of the parallel processes going on there. But yeah, I, and I managed to get a job in a, in a team in Kent and then we moved to Kent and I got this job and I think it was, I struggled working full time, but I really liked that I had a very specific job, doing a very specific role with quite a specific group of people. So I liked that a lot about that job. And we were a really small team, I was the only clinical psychologist in the team. And when I had my first child, I went part time, so I went down to three days a week and yeah, I went, so I went back to work three days a week and I found it was hard. I found I was working very hard in those three days a week. It was hard to do the service justice really, three days a week. So when I had my second child, my first child was due to start school. And as I returned from maternity leave, my then baby had allergies. And made it, which made it difficult to place in a nursery. Or I, I mean, I felt she was difficult to place in a nursery. I think like in reality, they probably would have managed, but I ended up, and because nurseries are long days and the school days are short and like organising childcare around those competing needs just felt impossible. And I felt like I'd have to ask for a further reduction in hours. And I just felt like I couldn't do the job justice on less than three days. And I spoke to my partner about whether I could go into private practice because, you know, it's a bit of a financial risk. And he kind of agreed to a trial period. And I was really lucky because I met Shabnam Berry Khan really early on.

Oh yes, lovely Shabnam.

And she set me up with some associate work which actually, they paid all the bills for us actually, you know, sort of straight away I had that financial security from the work I did with, with Siteworks. And then I gradually built up my own private practice of one to one clients, some via a third party who I won't mention because I don't like them very much. And, and some started finding me. I set up, we set up me and some local psychologists set up a Kent psychologist page and we started to track local referrals. But I was getting such a mix of people. You know, like my USP was that I was in Rochester. And that meant that I just got all sorts of people with all sorts of presentations and I had to go away and read about every single thing that I was doing.

Oh, it's so hard, isn't it? It's like being a trainee again. You're like, oh, I've got to look up an article on this. I don't know what the latest is on that. Yeah, it's really, really exhausting to do that.

So the imposter syndrome is high. You know, I was charging, you know, bottom end of the going rate. And I was working a lot. And it didn't feel very sustainable. Yeah, so, so I had some supervision sessions with Michaela Thomas, and we were talking about who my ideal client was, and I started to talk about clients who presented as quite overwhelmed. I was talking about mainly, mainly I've had a handful of clients who were women or they were trans or non-binary and they were coming and they were presenting as very overwhelmed, quite rigid in their thinking. And I'd really enjoyed working with these people. And as I was talking to her, I said, but am I talking about undiagnosed autism? And, and actually on reflecting on that, I said, and actually, am I autistic? Because that's been in the back of my mind for a long time. Like, I think, when I was when I was working in LD services in the NHS, I went to a lecture on autism in women and girls. And it, it really made a lot of sense to me. And I thought, oh, yeah, that's me. They're describing me. But I assumed that the knowledge, I mean, this was about 2015, and I kind of assumed that the knowledge hadn't filtered through to enough places about what female presentations looked like. So I kind of assumed that I would be dismissed if I went and asked for an assessment. I assumed that they would say, oh, you make eye contact, oh, but you're trained as a psychologist. And so I assumed I would be dismissed and obviously I'd been, I'd not been seeing my GP about any difficulties I'd been having, so I didn't feel like they would necessarily think there was anything to be gained from an assessment. But this conversation with Michaela, and at the same time, we were realizing that my eldest daughter was autistic. You know, it had become obvious, and she was, she was then getting an assessment. So yeah, so I went and I sought out a private assessment and I was very anxious that they would say that it was a bit borderline. I think that that's the kind of what I thought they would say. I thought they would say, oh, well, there are some traits, but you know, you're not quite, you know, you're not quite meeting all the criteria. And that I'd be left with something that felt poorly defined. And actually that wasn't the case at all. I ticked all the boxes. And I was diagnosed in 2018. Yeah, yeah. So yeah. And yeah, so I then, what happens to me then was I started to try and understand my whole life through this frame of autism. And I ended up having some private therapy with Tanya Thorne, who was amazing. We went through, we went through my entire life history in a way that I've never done with another psychologist. Not even with a therapist, you know, even when I, I’d paid to have little bits of counselling here and there throughout the doctorate. And I hadn't told them my history because I hadn't wanted them to judge me. I hadn't wanted them to look at my history and decide that and decide something about me. I think that's, that's what I did, I’d been avoiding. So, so I'd not been to therapy with my entire history. And I certainly hadn't shared it on the doctorate with anybody. And yeah, we went back through my life, sort of step by step. And it was an incredibly healing experience because I actually finally had an understanding for what had been going on all of that time. And I, I think I'd had a lot of professional shame that as a psychologist, I understood other people, like I think the psychology courses taught me quite well how to understand other people, but I still hadn't understood myself, I hadn't been able to formulate my own difficulties and so I'd had a lot of shame that I couldn't formulate why I was the way I was, and why I found life so difficult. And so I think I kind of shut myself off from it too. I'd shut myself off from my history. And so I had this real sense of integration, of this real sense of like integrating these two parts of my life that being so very separate, you know, they'd been like just being these different, in these very different roles. I, and yeah, so I started to actually associate with my former self, but where I hadn't previously. And around this time I started marketing more towards autistic people. So I set up my website and I did some, I did some blog posts and I'm trying to think what I did first, but yeah, I, I set up the website and I started to attract autistic people as clients. I had a psychology today profile as well. So yeah, I started to attract autistic clients and the more I read, the more I found I found out about autistic burnout, and I realised, I kind of immersed myself in the autistic community online as well. So, on Twitter, on Facebook, and I went on a couple of courses by autistic advocates as well as well as some, you know, by the big names in psychology. And I realised there was quite a big gap between what the autistic advocates are saying and what some of like the older school psychologists were saying, and it felt like, it felt like it would be quite easy to kind of feel like I was in one camp or the other. And I kind of wanted to be in, I kind of wanted to find a way of being in both.

That's really interesting. Can you say a bit more about what that gap looked like?

So I think. I think it's, I think the gap is getting smaller. I think, but I think back in, back when I started, you know, doing courses, I went on, I went on some courses by the likes of Tony Atwood, who, you know, who was always considered to be an authority in, in autism. And they were, they were useful, but I don't, I didn't feel he was talking about the people that I was seeing. I felt like he was still talking about people who were autistic and had a learning disability or you know, not kind of highly masked autistic people that I was seeing in my private practice and, and, you know, where, where I would meet the criteria. So there was a gap there. And also the autistic community, I think they decided they didn't like Tony Atwood because, because he'd said something that was anti-trans. Or something they perceived to be anti-trans. So, so they, so, so they've kind of written him off. And I think there were a lot of advocates who were actually incredibly well read and researched and very up to date and very engaged and very much listening to the autistic community. And now I've started to see like more people coming into that gap between the two. So, there’s the adult autism practice, there's, there's a lot of people actually there's a lot of people now who I feel quite confident to recommend, where they are, they are either autistic or they're listening to autistic people. So yeah, I don't think that gap is still there in the same way, but I, I think I needed to find a way of, um, being part of the autistic community and also being a psychologist, which has been a work in progress, really. I learned more about autistic burnout, and this is an area where there's, there's not actually very much research so it's quite an easy area to become well read in because you can read everything there is to read on it quite quickly. And yeah, and I then started marketing more towards autistic burnout. And I wrote a few blog posts about autistic burnout. And then my caseload became more and more about autistic burnout. And I was on Twitter, so I did, like, autistic Twitter is quite a big thing. Or it was, I don't know if it still is, but it certainly was a big thing. And so actually showing up there and being part of it regularly made a difference. And I put together a lead magnet. I put together you know, I used some of the research on autistic burnout that pulled out common symptoms of autistic burnout, and I put it together just as a symptom checklist. So just as a qualitative tool that people can use to just tick off symptoms they may or not be experiencing. And I put that up as a lead magnet on my website and I'd advertised it on Twitter. And I started getting people on my mailing list. You know, people really liked that. I spent time on Canva making it look pretty. People really liked it. And my blog posts started to do quite well as well on Google. And actually, before I went on maternity leave, so when I was then pregnant with my third child, without any kind of maternity package, I decided to try and put together a program, like a, an online course for autistic burnout, so that I had something to leave running while I went on maternity leave. Now I kind of over delivered, I kind of put a lot into it, I put too much into it, and I spent I spent a lot of time doing it before I went on maternity leave, so I didn't really wind down for maternity leave as I should have done. Because I was so, like, set on getting this thing out there. And actually it meant I didn't market it, so, so I, I put it up, pretty much like, put my out of office on. I did, I did send one email to my mailing list that was, I don't know, maybe about 2000 people on it by that point. I sent one email out and I went on maternity leave. And I had intended to carry on tweeting and blogging and things while I was on maternity leave and actually, that just didn't happen. Maternity leave hit me way harder than I thought it was going to and I did nothing for a year. But during that time those blog posts started to perform even better and that lead magnet continued to perform and I was getting about 500 new people on my mailing list a month without doing anything and ...

Well, let's think about that because you'd kind of already done something quite important, I think, but why do you think those people kept coming for your blog and kept wanting that checklist? Why, why do you think that was successful?

So, I had written the blog posts with the titles, with the words I thought people would be typing into Google, including how to get out of autistic burnout. And that is my best performing blog post. People type how to get out of autistic burnout into Google and boom, they find me.

Perfect. And I'm guessing that the kind of awareness around what autistic burnout is, what autism is, has kind of incrementally been growing over the past few years. And so it's not that surprising to me, really, that people would start Googling and looking for specific help, whereas before, maybe similar to your story, they'd been kind of floundering through diagnoses that just didn't fit.

Yeah, absolutely. So, so yeah, I think there's been that increase in awareness at the same time as I've, and I managed to get a little bit ahead of it. Yeah, so I'm coming back from my third baby and final, and definitely final baby. And I realised, and I realized that my website was getting about 20,000 hits a month, sometimes more. And that you know, my mailing list was continuing to grow. They weren't getting any emails from me, but it was continuing to grow. So I came back to about 6000 people on my mailing list. And I was very aware that I, I had made my life very stressful by having three children. Like lovely as they are, like I'm aware that I don't have enough control over my life and making it stress free and making it, making myself as able to regulate myself as possible. You know, time is a very scarce resource. Things happen and changes happen, and I need sort of extra buffering to allow for that. And you know, I need to not be masked, I need to not be pretending to be someone I'm not when I'm showing up with people, I need to show up as myself because that's a massive energy drain that I don't, I don't need. And yeah, I'm still working part time. And much as I love one to one work, I find it very hard when there's not space in my week. I really need some space in my week, and I really love writing, I really love writing blog posts, I really love writing online courses, really love having time to research stuff. You know, I'd love to write a book, I'd love to do, to do these things that actually do help people, but less directly and, you know, to actually be in there pulling apart the research evidence as it's being created and actually feeding that into practice, into clinical practice. So yeah, and I was also thinking, you know, 20,000 people hitting my website a month, you know, if just like half of them gave me five pounds, that was, you know, You know, that would be loads, wouldn't it? So, I thought I need a lower ticket offer. I've got this high ticket offer, it's a, I mean, it's a £500 course. And it has, you know, I sell a couple of months and I haven't marketed it that much. It's not perfect, you know, because it's an entirely online course. People don't get supported through it, and it's a lot of information. So yeah, it's not perfect, but if people want to just have the information to work through by themselves, which I, you know, that does appeal to a lot of autistic people, you know, it's there. And I thought I need a lower ticket offer. And I kind of had this, this dream of having a community where people could show up as themselves as their, their, you know, their fully autistic selves, and where they could talk about how hard life is and how we could talk about dropping standards to levels that, you know, neurotypicals might cringe at, you know. But, you know, like actually really keeping it real, really keeping it real, really trying to be accessible. And yeah, I kind of thought, you know, I'd love to have almost like a therapeutic community, but in a Facebook group. And so what I've created is this membership where there's a Facebook group that not everybody chooses to join, but there is a Facebook group. And every week we have a weekly check in where people rate their burnout. So there's a, there's a core module where they, we talk about measuring your level of autistic burnout. And we really go into the details because a lot of people go from 0 to 100 and they don't really know the incremental steps or what the signs were. So we really, there's like a whole module on working out how to gauge where you're at. And then, you know, these aren't always the normal ways of gauging things. These aren't like, oh, I'm 8 on my scale of burnout. Sometimes it's, I don't want to watch anything new on Netflix. That means I must be a 7, you know, you know, it's that, that kind of, you know, we find creative ways of gauging burnout. And then yeah, we have the weekly check in on Facebook and where people practice rating their burnout. We have like a problem-solving day where people can bring like practical problems that they feel embarrassed to ask elsewhere. Like, you know, how do I, how do I, how do I get from, how do I get out of my bed in the morning and, you know, make, make it to, to school? Yeah. How do I get through this process that I can't quite structure? So yeah. So we have that, and then we have a Friday review where people review the week, what went well, what didn't go so well, you know, what helped, what they're, what they're going to do for next week. And we also have like a weekend fun post where people are encouraged to share special interests and to really feel allowed to really share their special interests, and not be you know, worried that overdoing it. And then they get, they get a monthly workshop. So, this month, well, yeah, we are just at the end of November, aren't we, we'll be recording. So, this month, it was all about self-criticism and autistic burnout and how self-criticism can maintain autistic burnout and how it can be a barrier to recovery. And that went really well. So, I ran it live twice. I didn't really want to run them live because I, I am better if I have time to think about things in advance. But I know I've got a lot of clients that are also, also ADHD and, and for a lot of people actually, unless it's live, they just won't do it. So, so I do run it live twice. I have support. So, there's a lovely peer support organization called All Peer and they are an autistic peer support group. And so I'm able to pay them to support me, which then brings them in revenue for their CIC. So that, that feels really nice too. And yeah, it's available pre-recorded for the whole month. So they have access to that for the whole month and they can download it. But it is then disappearing content. So, and I've done that for two reasons. Like one, I didn't want people to be able to join and get access to a whole back catalogue of things that I might be able to sell separately. But also because I think it would be overwhelming if they were to come into a membership and have a massive library of content and feel like they needed to work through it to get their value for money. And, you know, these people are either in autistic burnout or they're feeling at risk of autistic burnout. So it's, it needs to feel manageable.

That's really smart of you. I mean, I think often it's that one thing that you've done really well because you're in the demographic that you're serving, is putting yourself in the shoes of the people using the service all too often we think, oh, I'd like to do this or we let our imposter syndrome guide us to creating massive online courses with huge amounts of research in there. We're not actually thinking about the user experience and what it's going to be like to open up your browser and see a hundred masterclasses. I've been guilty of it. You know, I've created several courses where I know there's been way too much stuff. But I think, you know, you've really put the people you're serving at the front and centre of this. And one of the reasons I wanted to talk to you about your membership today is because so many people struggle with, should this product be a membership or would it be better as a course, and you've just described perfectly an excellent rationale for turning something into a membership. Because that's the only way it works, it's the only way you're going to get this sense of community, allow people to, you know, share their special interests and, you know, talk about the highs and lows. And I love what you're doing with helping people to rate their burnout as well. That can only happen in a safe community. And I think also it can only happen in a paid for community. Because you've got that buy in and commitment. I am going to keep coming back to this group because I paid for it, which is really difficult. I've tried to achieve that in, in free spaces before, and it just becomes unmanageable. Yeah, really difficult. So I think a really nice example of the, the right product for the people you're trying to help and delivering it in the best way for them.

Yeah, I think something else I've realised is that when people are paying for something and it's, it's currently £40 a month, so it's not a small investment, but when people decide to part with that much money, they've already bought into you, they've already read your stuff and decided they liked your approach, which means that the people you then get in that group are easier to work well with because they already like your approach, you're not having to change your approach to meet them. You know, I mean you are changing your approach to meet these people, to some extent you're listening to your membership, but you are, you know, they're self-selecting, they’re self-selecting to something that they think is going to be helpful because they've already read some of your stuff and they've already decided they like you. But like, know and trust, isn't it? They've already decided that and that makes your life a lot easier than if you're offering something and trying to please everybody, you know, who might be wandering past. Yeah, so it's really helped me. It's helped me massively to be very niche just because of the way my brain works and the way that I am very much better at focusing on you know, the very narrow range, but to a great depth of subject matter. You know, that really helps my brain. And actually it feels easy. It feels easy for me to do this. It feels easy for me to work, and I work very hard when I get time to work. I work very hard. And I feel quite invigorated by it because it feels, it feels so, it feels so much like this is, it feels so vital both for both for my clients, but also for me, like I need to be living this and I know I need to be living this. And there's nothing that makes you live it like actually teaching other people, you know, because you like, you don't want to be a hypocrite. You don't want to be yeah, you don't want to, you don't want to be peddling something that you're not prepared to do yourself. So, it's been massively helpful for me to do it too. And to be able to show up as myself and as a psychologist, which is something that I thought I could never do. You know, you know, coming on this podcast today and telling you about like, pretty serious mental health history, you know, I wouldn't have dreamed of doing that 10 years ago. I would've I, I would've thought, oh, I couldn't possibly do that. What will people think of me? They might think I can't be a psychologist. I think I'm, I'm fundamentally flawed as a human being. And yeah, now I think actually this is, this is the only way I can really be in this world. I need to show up as myself and I need to show other people that it's okay to show up as yourself, and it doesn't have to look the way you think it has to look. Yeah, you need to find, and that's it, like finding a way of working that works for you. Yeah, I'm in a membership for a lady that helps people to run memberships and she talks about, build something you want to build and then see who you attract to it. And I, you know, I do think there is something to be said for like looking at the evidence base and looking at what other people want as well, but I also think that's quite freeing to say is this, what work do I want to do, and actually is there a market for that.

Yeah, I think that is really important because, you know, for some people there would be nothing worse than having to manage a Facebook community, for example. And trying to force yourself to do something that doesn't fit the way that your brain works is just super painful, and you will never do it consistently. So I think it's, it's been really helpful for you to tell that story of finding that balance and finding what does work for you. One thing I'm curious about is, you know, sadly, I'm not surprised by the really ignorant responses that you received you know, around the training program and throughout life. Where do you think we're at with that? Is that shifting and more people recognising autistic burnout? But also the strength and lessons that we gain as clinicians from having been through some of those challenging times? What's your perspective on, on that?

Sorry.

Well, I'm asking a really difficult question, because I'm basically asking, are we getting better or not?

So are we getting better? In terms of understanding and treating autistic people appropriately, I guess that's one thing, isn't it? We are, I've, I've been disappointed really like I've had a few, I've had a few really young clients come to me. By really young, I mean like 18, 19, who I kind of assumed that they had been diagnosed early in life, and they hadn't like they'd already, they'd already been hospitalised. They'd already been diagnosed as psychotic. And then and then st like at 18, someone had thought maybe they were autistic and then decided to assess them. So I, and I was really quite upset by that because yeah, I certainly met one young person who had had a very similar history to me. And I had thought that, I mean, I'm nearly 40 and I had thought that my experience as a teenager was a, you know, symptomatic of being in the 90s. And actually, I don't think it's always that much better. I think sometimes it is, I think, you know, it's very much luck of the draw, isn't it? I have had more contact with NHS services recently, personally, partly because in private practice I no longer have to fill in occupational health forms, you know, I need to look after my mental health to maintain my HCPC registration. But actually no one's asking to see, you know, occupational health aren't going to refuse me a job anymore. And I've had some very good experiences of professionals, and I've also had some fairly poor ones, and I'm still reluctant to go via the NHS, I think partly because it's massively underfunded and, you know, the services aren't necessarily there anyway. But yeah, but I think there is a… I mean, we, we see it even amongst our, our colleagues, like the, the level of understanding, the level of buy in to the neurodiversity paradigm is, is very mixed. So yeah, I would never want to put someone off, like trying to seek help on the NHS because sometimes, sometimes people do get a really good service. And I certainly have colleagues working in adult mental health who are realising that maybe a third of their caseload are neurodivergent. And I think that's, I think that's accurate and I think, I think there's a lot of people that have been long term in mental health systems, and where neurodiverse, neurodivergent sorry is part of their… it would be, it would be a helpful part of a formulation for them. I can remember Tanya Thorne saying to me, yes, it does have high explanatory value, doesn't it? And I love that term. It's a good way of fitting it, yeah. Really good way of putting it. It really felt like it had high explanatory value for me.

I mean, one thing I've noticed which I'd be really interested to dive into the research, whether it's there yet or not, is around, who gets the neurodivergence picked up and who doesn't, because one thing I've noticed with NHS services is that it was kind of easy to get help for my son and very, very difficult for my daughter. When I would say, you know, their struggles are different, but they deserve parity. Absolutely. And yeah, so I wonder if it's harder for some groups. And I'm thinking as you were talking about the people we typically see on wards and how, you know, definitely when I, and it's been a long time, but when I was last in that environment, the formulation was often, you know, nobody cared about the explanatory power, basically, the formulation was just, they've always had this, medicate them. I don't know why I'm laughing about that. Nervous laughter. It makes me upset. But yeah, so I imagine that we'll make progress for some groups first, and then we need to really put the effort into making sure those other groups get the same progress.

Yeah, because of course our children have the benefit of having us as their parents and you know, us knowing what's, you know, having a really, having really good insight into what's going on.

Yeah, but I don't think I did actually. So this, I don't, so I worked in learning disability as well in the NHS. And I also specialised in non-speaking people. And I certainly have always been drawn, I think to that sort of work. And I was interested in neurodivergence, but when I left the NHS, something like PDA, for example, I'd read one paper on it. Really, there wasn't an understanding at all. And so when I was blessed with two autistic PDA ADHD children, I didn't really know what I was looking at, and yeah, I think it's been a real journey for me over the past few years to learn about that and learn about everything we know now about how things can present so differently. So I think for a loss of, you know, clinical psychologists and other mental health professionals listening to this, a lot of us have still got a huge amount to learn.

Yeah. And I don't think it was included in our training. I don't know what the training courses are like now, but it certainly wasn't when I trained in 20… well, I graduated 2012.

Yeah. Yeah. No, it wasn't. It wasn't anywhere. I think we, we did a little bit on autism, but it was the Tony Atwood, you know, mostly relevant with learning disability stuff. So, I think we've come a long way, but I still get the sense that there's an awful long way left to go.

Yeah, I think there really is. Yeah, and I think it's really important, I think, you know, I understand people get into a debate about how useful diagnoses are, but I think If we are looking through the lens of neurodiversity as like as a natural form of diversity that's existed for. existed forever, and where you know all neurotypes have something to add and are useful but also come with their own challenges, and, you know, some of which are not well accommodated by this society. You know, I think that's actually very helpful. And certainly, it's certainly a better formulation than I must just be an, like a subhuman person, or I must actually just be, yeah, just really, just faulty in some way. Yeah. Which is, which is, you know, that was my alternative formulation. So, so yeah, I, I think there's an awful lot of value in it.

Yeah. Thank you. I know it's still controversial to talk about, so thank you so much for sharing that perspective. And you know, for what it's worth, I'm completely with you, you know, having two children thinking about what would, what would happen if they didn't have their diagnosis? I just think, yeah, I think I really see the power of it and the good of it. And I hope that it will help alleviate some of that shame, because they were already feeling it at six and five.

Yeah. So that's it. My, my partner has ADHD actually, and he was always, he always thought he was lazy and, and that was, you know, that was, that was the lesson that he was taught about himself. And I, I think that's it. That's the thing that gets internalised, it isn’t helpful. Yeah, that's, yeah, it's not helpful.

Absolutely. So, thank you so much for joining us on the podcast today. It's been really fascinating to hear about your story and really inspiring to hear about the work that you're doing. I have got no doubt that people listening to this are going to want to go and look you up. They must look you up actually, to look at that fantastic website for a start. So where is best for people to go and find out more about what you do?

So my website's www.dralicenicholls.com yeah.

Brilliant. The link will be in the show notes. And I really do want all of you to go and look. It's a really great example of a brilliant website that works really well for the people that need it, and communicates what you do absolutely beautifully.

Thank you. Thank you so much for having me. I've really enjoyed talking to you.

Thank you for coming on.