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.

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.

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.

 

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

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

Celebrate Stepfathers on Fathers Day

Stefather and child at beach
Photo by Derek Thomson on Unsplash

Let’s take time out to acknowledge and celebrate stepfathers on Fathers Day.  Over 20% of  Australian children live in step or blended families, therefore, thousands of men are stepping into an ambiguous and difficult role.

Those passionate and delightful “in love” feelings couples experience in a new relationship don’t necessarily encompass your new partner’s children. And kids don’t Continue reading

The Psychologist sounds out the Music Therapist

Music Therapist, Claire Stephensen from Press Play Therapy
Music Therapist, Claire Stephensen from Press Play Therapy

At times the rumble of drums or the soft tinkle of ivories floats into my counselling room at Little Window – Counselling, Psychology and Wellness. Then I know that our Music Therapist, Claire Stephensen, is working with a client, and I’m intrigued.  Poking my head into the hallway, I try to see Claire using music in therapy, but her door is firmly closed and the mystery remains.

would not describe myself as a musical person. I sing like a cat on heat, I’m an awkward dancer and my husband used to tell me off for singing Twinkle Twinkle Little Star out of tune to our children. Yet I also know music brings great joy. I hear the first beats of an old love song and memories flood back. My mood can be lifted or lowered through a few well-chosen songs. I know that there is magic in how we respond to music. To satisfy my curiosity about music therapy I had a chat with Claire and asked her a barrage of questions.

Thanks for having me Anne, I know your curiosity is shared with so many people.  I look forward to sharing a glimpse into the ‘music therapy space’.

How do you start a music therapy session?

In music therapy training we learn a lot about the importance of overall structure of a session – the opening, middle and close are each considered to be very important for their own reasons (just like the open, middle and close of a song or piece of music!) – and it will look different for each person I work with. I always intend to meet the person where they’re at – and finish the session closer to where they want to be. For some, this might mean we start with talking before introducing music, and for others, we start with music before we do any talking. Some clients like to start their sessions by bringing a song or piece of music that resonated for them – to help bring language to their current challenges. At other times we talk through the key challenges or wins so we can decide together what the best modality will be for the ‘middle’ part of the session.

So you do talk during music therapy?

Continue reading

“Comparison is the death of joy” and an unhelpful thinking habit

I came across the quote “Comparison is the death of Joy” by Mark Twain the other day and was struck by how succinctly it captured what I frequently hear, and occasionally do. Consider the following ways that joy is killed.

The new mum

Comparison is the death of joy

The new mum gently nestles her beautiful baby boy in her arms. She gazes lovingly at her son, stroking his hair. He’s snuggled in a bunny rug, blissfully milk drunk.  She’s just finished breastfeeding him, happy to do so in front of me.

She dips her head away from my inquiring eyes. “He wakes more at night than my friends baby”. Continue reading