How many tears did I miss while doing Telehealth?

Wow, what a year! As a psychologist, the 2020 Covid-19 pandemic barrelled through my work, rest, and play, leaving me besieged with questions.

Work

Telehealth equipment including laptop, phone, earphones, tissues.One week I was delivering face to face therapy, the next week I was huddled in my spare bedroom providing telehealth on the phone and through video for 8 weeks. Clients embraced the technology, and therapy continued much the same as it had before, or did it?

Did clients feel safe to talk?

I spoke with clients who were secluded in their cars, curled up in their bedrooms, or who had escaped to a park. We work so hard to make our therapy rooms a place of safety and comfort, and they laid abandoned.  Now I could hear other people in the house, or strangers wandered past as we talked. How were our conversations altered by the lack of confidentiality?

What happened to that space where clients travel to and from therapy?

The coming to and going from therapy is part of the reflective process. You make space and time for yourself, travel there, arrive, settle in, engage in therapy, and then travel away.  What is the impact on the therapeutic process when you just move from the lounge to your bedroom, or when you continue doing chores or parenting while you talk?

How many times did I interrupt the process of therapy?

I would barge in asking “Can you still hear me”? Or ask clients to repeat themselves as I strained hearing only every fourth word on a video call because of that annoying delay. Those spaces of time where no one speaks have a  multitude of meanings in therapy: “I don’t know what to say next”, “I’m overwhelmed”, “I’m angry or sad or tired”,” I’m reflecting and processing”, “It’s too much”, “Stop, “Go on”.  The silences were much harder to navigate on the phone or even by video.

How many tears did I miss?

I learned that the glistening of teary eyes is impossible to see over the phone and difficult over video. How many times did I not pause to honour the tears? How many other emotions did I misinterpret or not notice?

How do I hold space for clients when I am navigating the same storm?

As therapists, we become adept at tracking and managing our own emotions during sessions so that the focus remains on the client. I’ve been aware of an increased need to do this as clients express their fears, grief and anger of living through a pandemic. I could so often say “me too”. I’m continually checking in and asking myself (and clients) “What do I need to do to care for myself today?”

What will work look like in the future?

Clients, friends and family have shared how they loathe or love working from home. Some feel released from the cacophony of noise, people and demands. Others are grieving the loss of human connection.

I cringe when I hear organisations stating how wonderfully productive working-from-home has been and how they will be implementing it for their employees in the future. I’ve heard too many stories of people overworking due to boredom during lockdown or fear of job losses. We are only at the beginning of this forced work-from-home pandemic experiment. What may have been expedient in the initial sprint of the pandemic may not be sustainable in what is turning out to be a marathon. How will friendships develop with reduced work socialisation? How do you build trust in a team when you are rarely in close contact? How many more lonely people will we have in Australia? Will employers make workplaces leaner and meaner and perhaps insist employees work predominantly from home as a cost-cutting move? How can we design better lives for ourselves as we come out of this pandemic?

About 30% of my work continues to be telehealth which is fantastic for clients who, for whatever reason, cannot come in for face-to-face sessions. I am grateful the intensity of delivering telehealth has eased for me and commiserate with colleagues delivering telehealth full time, even though I know some like it. After a day of telehealth, my body was stiff and ached with the increased concentration, my eyes were sore as if I was trying to use them to listen and I was emotionally spent. Do I need to upgrade my computer and earphones or source an ergonomic chair designed for telehealth? Would it make that much of a difference if I did?

Rest

How can we maintain the sanctuary of home?

I’ve vigilantly kept home separate from work, and I like it that way. During my work-from-home period, my haven was temporarily invaded, not just by my work but also by my noisy husband. After 35 years of marriage, I learnt my husband talks a lot at work, much more than I ever imagined! His voice echoed through the house until I banished him to a bedroom. What did others learn about their partners during this enforced episode of closeness? How did others maintain the sanctuary of the home, or was it not important to them? Is delineating between work and rest important? Are people now sleeping and being intimate in their workspaces?

Why didn’t I buy shares in home renovation and craft businesses?

2020 Pandemic Christmas Wreath
2020 Pandemic Christmas Wreath

Before we went into lockdown I encouraged my family to buy what they needed for those small home reno projects and to stock up on art and craft goods. I celebrated rooms painted, pots decorated, furniture made and first-time attempts at embroidery. I received the most beautiful hand made mothers day card. I feasted on new menus. I heard songs broadcast by those who had been too scared to perform.  I learnt to crochet via youtube and created a Pandemic Christmas Wreath. Each year as I hang it I will remember 2020 as the year that was like no other.

As people experience the rhthym, creativity, passion, problem-solving, absorption and satisfaction that art and crafts bring will they be re-valued and retained in our post-pandemic world?  Are art and craft the richest form of mindfulness?

Play

How do I socialise?

For me, play is dominated by spending time with others, particularly those I love. I hold increased gratitude for those who live geographically close to me and to those who have continued to include me in the rhythm of their lives. Friends who meet me regularly for walks help provide a missing structure. I find it unexpectedly difficult to organise meeting up with others. It’s as if spontaneity has seeped out of me. How will I rekindle it? And what about the planners who love to see a full diary, how are they managing?  What are people looking forward to?  It’s as if I’m looking at the world through dirty glasses, something is not quite right yet I can’t wipe it away. How would others describe their experience?

Have communities changed?

Group of neighbours socialising in cul de sac.My Tarragindi neighbours organised regular pandemic drinks in our cul de sac on Sunday afternoons. Initially, we social distanced, calling to each other from across the road. As the pandemic eased in Queensland we became closer.

On ANZAC Day my husband trumpeted The Last Post from our driveway, neighbours joining us from a distance, telling us it was the most moving ANZAC Day they’d attended.

I now know my neighbours far better than I did at the beginning of 2020. Will we continue with these new social traditions? Do communities feel closer now or more distant? Will the way we make and sustain relationships change?

When will I see my family and friends?

My arms ache to hug my daughter, brother, sister, parents-in-law, nephews, nieces and friends. No matter how many video calls we have my most pressing question remains “When will I see my daughter again?”.

Anne Moorhouse, Psychologist

 

Midnight worries for weary psychologists

Closeup portrait of dissatisfied middle-aged pretty woman covering ears with pillow and lying in bed in bedroom. Top view.

 

 

 

 

 

 

 

Update:  2020.  We have suffered through the Australian Bush Fires and now are in the midst of the Covid 19 pandemic.  People have lost their jobs, their homes and their lives as they know it. There is an increased demand for bulk billed mental health services.  After a week of providing bulk billed telehealth to clients it is clear, that despite our best intentions, the bulk billing rate is unsustainable.  At this time telehealth can only be bulk billed.  We are unable to charge a gap fee. Psychologists will be unable to pay their rent and put food on their table. It is devastating.  We need an increase in the bulk billing rate.  Please sign the petition Increase Access to Essential Psychology Services – End Two-Tier Medicare.

After a day working with vulnerable people, many of whom have been hurt at the hands of others, its no wonder that psychologists often have difficulty nodding off to sleep at night.  Yet it’s not worrying about clients that keep many of us awake.

Midnight Worry No. 1 – Can I survive financially?

Psychologists, particularly if they are in private practice, worry about whether they can continue to make a living. We know that many vulnerable clients who require psychological treatment, often have difficulty paying for the service.  You cannot sustain a psych0logy practice by bulk billing clients ($86.15 Medicare payment) and also pay rent, insurance, professional development, administration costs, superannuation, sick leave, and holiday leave. One restless night I calculated what my income would look like if I tried to bulk bill.

Gross Income Costs Net Income
Bulk billing income
$2,153.75 x 46 weeks (4 weeks holiday and 10 public holidays)$86.15 per hour x 25 hours = $2,153.75 per week
25 clinical hours is a full-time workload with time to do the myriad of other tasks including liaising with doctors, schools, and solicitors.
$99,072.50
Superannuation
As a predominantly female workforce let’s not join the growing ranks of women over the age of 55 who have no superannuation

$9,411.88

Psychology Board of Australia Registration $486.00
Professional Indemnity Insurance $500.00
AAPi Membership – Join here $250.00
Mandatory Professional development $400.00
Mandatory Supervision $2000.00
Rent – $600 per week $31,200.00
Additional expenses – 20% of income
Conservative estimate of small business operating expenses including admin support, accountants, legal advice, utilities etc.
$19,814.50
  $35,010.12

I feel sick about this, but  I have not calculated an allowance for sick leave. If you’re a bulk billing psychologist it’s unlikely you’ll be able to charge clients who don’t turn up. Most psychologists don’t have a full diary of 25 clients attending each and every week.  Now I understand why psychologists need to charge at least twice the bulk-billing rate.

At the end of the year, the tension around the cost of psychological services is exacerbated as many clients have used up the 10 subsidised sessions provided by Medicare for a calendar year. All psychologists hate those days when clients ask us to reduce our fee, or even worse, provide a free session.  It’s like choosing between providing the service to the client and paying your own bills.

How do you tell a mother, who’s recently left a DV relationship, that you won’t see her 13-year-old daughter who has started self-harming until January next year when Medicare kicks in again?  Not much point in asking her RUOK if there is no alternative service to refer her to. That’s the stuff of our nightmares as I wrote in Dear Mental Health Client, please don’t be too unwell.

Midnight Worry No 2 – What to do about workplace discrimination?

Many psychologists know their employment choices have been unfairly reduced. Jobs for psychologists are sometimes advertised as only being available for those with clinical endorsements, without any rational reason. This unfairly disadvantages most psychologists (and clients), for no valid reason. Some of us toss and turn at night trying to make sense of an industry that eliminates highly qualified and experienced candidates from jobs. It’s hard to sleep when your enraged – Enraged psychologists fighting for an improved mental health system

Surely Australians that use government-funded mental health services have a right to expect that they will be seen by the most appropriately skilled psychologist available? There are 30,385 psychologists in Australia of which only 9,000 have a clinical endorsement. That’s a serious reduction in the pool of candidates.

Midnight Worry No 3 – Why is psychology a split profession?

Psychologists are anxiously waiting for the outcome of the Medicare Benefits Schedule Taskforce Review into Mental Health. If the recently released MBS Eating Disorders changes are indicative of what’s coming, the pay disparity between psychologists with clinical endorsement and those without will be magnified. A client who sees a psychologist without clinical endorsement will receive a Medicare rebate of $101.35 whereas a client who sees a psychologist with clinical endorsement will receive a rebate of $148.80.  Both psychologists will be doing the same work.  Holding a clinical endorsement does not mean the psychologist has a higher level of education, expertise or experience.

No wonder many of us can’t sleep when we find ourselves sitting next to another psychologist, equally experienced, educated, skilled and professional (and often our friend), yet for some unfathomable reason, they are being paid almost $50 per hour more, for providing exactly the same service. If psychologists who are not in private practice don’t think this affects them, watch what happens to even more job advertisements as this disparity continues and becomes embedded as the status quo.

If you think the profession is not under attack read this insomnia inducing diatribe against psychologists, social workers, and occupational therapits by Judy Hyde, Past President of Australian Clinical Psychological Association on 30/10/2019 –New system for eating disorder treatment could expose patients to ‘great danger’, experts warn. 

Midnight Worry No 4 – Do psychologists really care?

Throughout history, it has been the inaction of those who could have acted; the indifference of those who should have known better; the silence of the voice of justice when it mattered most; that has made it possible for evil to triumph. - HAILE SELASSIE , ETHIOPIAN STATESMANThere is an energetic Australian Psychologist’s Facebook Group, but we need thousands more members. Could our membership reach 20,000 and include most Australian psychologists? We need the power of numbers to allow the dissemination of information. This is a great use of social media. Do psychologists really care what’s happening in their profession? Do they care about how this disadvantages their clients? I’ve contemplated this before – Uniting Psychologists: Visionaries, Activists, Noisemakers… and Bystanders. In the midnight hours, I ponder whether psychologists are complacent, apathetic, overwhelmed or disbelieving, I haven’t yet come up with an answer.

The Australian Association of Psychologists Inc (AAPi) provides a viable and ethical alternative to the Australian Psychological Society (APS). The APS has to take responsibility for the mess the profession is in now. They have not been advocating for the majority of psychologists. AAPi needs the power of membership numbers to negotiate on our behalf, and on behalf of clients. Yet many psychologists remain members of the APS, which continually fails to represent them.

I recently bumped into a young ex-work colleague, she’s a psychologist establishing her practice. I explained what was happening and referred her to AAPi and the Australian Psychologists Facebook page, but sadly her response was that she didn’t want to be “political”. Similarly, another psychologist on maternity leave maintained her APS membership for fear of retribution, even though she was adamant that they’d done nothing to assist her career. It’s not a requirement that psychologists are members of any professional organisation but both these young women have the most to lose in the current situation, and would benefit from an organisation which represents them, and their clients.

Dreaming of a way forward

The way forward is for psychologists to actively engage in protecting and growing their profession. We must be proactive to ensure clients can access a diverse workforce of psychologists.

Urgently sign the petition to demand an equitable bulk billing rate. The bush fires and the covid 19 pandemic demand have lead to a rise in the demand for mental health services. Increase Access to Essential Psychology Services – End Two-Tier Medicare

Join the Australian Association of Psychologists Inc  – it’s only $250 per annum for a full-time psychologist and $100 if you’re part-time. If you are too fearful to leave the APS then at least be members of both!  Follow them on Facebook, Linkedin and Twitter too. Students can join for free.

Join the Australian Psychologists Facebook Page – it’s a closed group and they’ll ask you some questions to check you’re not a robot, and that you are a psychologist.  It’s an amazing community of psychologists.

Disseminate information.  When you see an ad or article from AAPi share it on Linkedin, Twitter, and Facebook.  Email information directly to psychologists who you know are out of the social media loop.  Talk to your colleagues.

Unite. Share your concerns with your clinically endorsed colleagues. These may be difficult conversations but it may be the only way to dispel the myths surrounding the split and to unite the profession.

Share this article with every psychologist you know and ask them to share it with every psychologist they know. Share AAPi posts and information.

Goodnight and sleep well.

 

Active, Balanced and Connected – and over 60!

Road sign enjoy at 60 - active balanced and connectedWe celebrated my brother’s 60th birthday with Takaro Trails three-day self-guided cycling tour of the Hawkes Bay in New Zealand. There were four of us over 60, and one young man of 59, my husband Steven.  While laughing, riding and celebrating life “active, balanced and connected” became my mantra for healthy ageing.

Active

Riding through the Takaro Trails I contemplated the opportunities in my life to remain active.

Keeping my mind active will be easy, I hope. I love to read, listen to podcasts, write and play computer games. Social injustice still fires me up and I’m curious about the world. I delight in talking to young people and discovering their views. Even though my adult kids roll around the floor laughing at me, I enjoy learning new technology and embrace social media. I still work part-time as a psychologist and I remain committed to my professional development. I’m inspired by the hopes and dreams of colleagues and clients.

cyclists on track active balanced and connected.Keeping my body active will be more of a challenge. Despite this bike trip, and that I also rode the Otago Rail Trail, I’ve never particularly enjoyed exercise, yet I know how essential it is. I do enjoy an easy cycle at the weekends and have sometimes regularly ridden my bike to work.  I dabble in a bit of yoga, and I particularly like Yoga with Adrienne’ videos. Some mornings I manage to get myself out for a walk. My most active engagement in group exercise was through NIA dance and exercise classes. I kept that up for two years and will probably return to the welcoming group. Pottering in the garden brings me great pleasure and is another of my active pastimes. I purposefully increase my incidental exercise too, often parking Continue reading

Waiting outside the psychiatrist’s office

Getting there

My friend is terrified of lifts so we climbed up the dingy stairwell to the third floor, only to find our exit door locked. After pointlessly pulling at the securely locked door a few times, we turned and scurried back down the stairs, to find the door we’d entered through also locked. Anxiety slowly rose in my throat. What if we’re stuck in the stairwell for eternity?

Empty office corridoor

Frantically, we descended further flinging open the lower ground floor door to the street, bursting out into the bright sunshine. We re-entered the building, now no option remained but to brave the lift. My friend scooted into the back corner, her body firmly pressed against the walls, arms folded against her chest. Her eyes startled with fear and yet also relieved that we were the only ones locked in the confined, windowless space that she hates so much.

The long hallway to the inner city psychiatrist’s office was bland and soulless, terracotta tiled floor, cream walls and mission brown fixtures – a flashback to the ’70s.

Waiting outside the psychiatrist’s office

The psychiatrist, unknown to my friend or me, greeted her warmly, even though we were 10 minutes early.  The psychiatrist had received a myriad of documents and clearly knew that this appointment was going to be distressing for my friend. Despite the kindliness of the psychiatrist, my friend looked pleadingly at me as she slowly followed her to the psychiatrist’s office.  She Continue reading

Estranged mothers and adult children

woman sadIt’s Mother’s Day this Sunday in Australia. A day when many families come together to rejoice in the loving bond between mothers and children. A day to celebrate the blood, sweat and tears that ooze out of mothers while raising children. But for some families, it’s a day of heartbreak. There will be no bunches of flowers or boxes of chocolates. Adult children and parents can become estranged to each other. That’s tough.

Those that choose to break the relationship with their parent or child, often see it as a move of self-preservation. For some reason, the family dynamics have gone awry and the person, unable to stand the emotional turmoil, chooses to leave. A broken attachment can feel calmer and safer Continue reading

Uniting Psychologists: Visionaries, Activists, Noisemakers… and Bystanders

A feisty shake-up of psychology

The profession of psychology is undergoing a feisty and invigorating shake-up, triggered by the Medicare Benefits Schedule Taskforce Review into Mental Health. For too long psychologists have trustingly left the management of their profession to the Australian Psychological Society (APS) and the Psychology Board of Australia (PsyBA) which is supported by the Australian Health Practitioner Agency (APHRA). We now realise that these organisations have not advocated proactively for most psychologists, nor for mental health clients, and the result has been a fractured profession. A cohesive mental health service for the Australian community can only be provided through unification.

There are now many more psychologists clamouring to be heard, stimulating hardy debate, challenging untested myths and demanding a united and yet diverse profession to meet the needs of mental health clients in Australia. If you are a psychologist, look at the Australian Association of Psychologists (AAPI) and Reform APS (RAPS) websites and join the Australian Psychologists closed group Facebook page.  These forums have re-ignited my interest in the profession of psychology, dormant for many years, having long ago let my APS membership expire for lack of relevancy.

Uniting psychologists

All psychologists are registered practitioners with APHRA under the general registration standard. A false dichotomy has arisen between psychologists with a clinical endorsement and those without. Those with clinical endorsement have been privileged financially (without any evidence of better outcomes) and are falsely assumed to have greater expertise, knowledge, and education.  In 2018 there were 29,982 registered Psychologists, with only 29% of them having a clinical endorsement. Eighty percent of psychologists are female.

We must celebrate the richness of diversity that different pathways to registration as a psychologist bring to the Continue reading

Dear Mental Health Client, please don’t be too unwell

Dear Mental Health Client,

Mental Health ClientYou came quietly into my counselling room,  looking a bit unsure, eyes cast downwards.  Hesitant to speak.

It had been tough to pluck up the courage and ask your GP for a referral to a psychologist. You hardly ever see your GP and felt uncomfortable when they asked about your mental health and living situation. You gave the GP brief answers, just wanting the appointment over and done with. This stuff so hard to talk about.

Starting your treatment

Mental health clientYou left the GP with a Mental Health Care Plan for 6 sessions, a bit surprised to learn that they’re not free because most psychologists can’t afford to bulk bill. Ouch, this is more expensive than you anticipated. You also learned that you can only have 10 Medicare subsidised sessions each year.  Still, you think, 10 sessions must be enough for the psychologist to “fix” you. Why else would they only give you this many? It seemed like quite a lot of sessions at the time.

It was so hard for you to come to the first appointment. Initially you tell me you are “just a little bit depressed and anxious”. By our fourth session, you’ve trusted me enough to share the Continue reading

Enraged psychologists fighting for an improved mental health system

Enraged psychologistI’ve never met so many enraged psychologists as I have in the last six months. We’re channelling our pent up fury by pounding keyboards, our battle cry is echoing loudly through social media and Members of Parliament (MP’s) are being accosted at every opportunity.

And that goes against everything I know about my usually sedate and contemplative colleagues.

Life of an enraged Psychologist 

Let me tell you a bit about the life of a psychologist. We work with vulnerable people in our Continue reading

Live like a giraffe in 2019

Giraffes Crescent IslandMy new year started on safari in Kenya. One of the many amazing highlights of this trip was walking with the giraffes on Crescent Island, Lake Naivasha. It was like wandering through the Garden of Eden and it was easy to imagine the birth of humanity here.

Watching the gentle and majestic giraffes inspired my new year wishes.

How to live like a giraffe.Giraffes Crescent Island

Walk with dignity, purpose and pride.

Hold your head high and look beyond the petty irritations of life.

Remain calm under all circumstances.

Stay connected and protected by your family and friends.

Happy new year to you all.

Building connection and intimacy through Mindful Coupling

Mindful coupling cardsAs a couple’s therapist, I’m always on the lookout for new ways to build connection and intimacy with couples.  I was delighted when I discovered an ex colleague of mine, psychologist Iris Goemans, had created Mindful Coupling.  This innovative tool for couples is like a delicious box of chocolates, full of unexpected delights.  I asked Iris to tell me more about Mindful Coupling…

 What is Mindful Coupling?

Mindful Coupling is a relationship card set designed to help couples reconnect, reawaken and rejuvenate their relationship.  It includes 30 powerful weekly actions and 64 intimacy-building questions to strengthen a couple’s bond, deepen their connection and enhance intimacy. 

What inspired you to create Mindful Coupling?

Love is one of the most profound emotions known to human beings. Romantic relationships can provide a deep source of fulfilment and can be a very meaningful part of our lives.  However when I looked around me, I noticed very few relationships that were actually doing well.  I noticed many couples feeling dissatisfied in their relationship and disconnected from each other, and that this was causing a lot of anguish. As a wife and mother myself, I understood that feeling disconnected can easily happen, especially when you’re running a household, looking after children, maintaining jobs, and generally trying to keep on top of all the other things life throws at us.  People tend to think that the grass is greener on the other side, but it’s actually greenest where you water it.  Continue reading