A number of publications are directly relevant to the wellbeing of healthcare professionals – you can find these below:

The Burnout Booklet

The Burnout Booklet: A Health Resource for Patients and Practitioners By Katharine Murphy and Olivia Glaze

This beautifully illustrated booklet draws on lived experience of burnout to offer a range of metaphorical ways of describing burnout. I often talk about how the word burnout can mean many different things, and it’s important to understand the individual experience of this to be able to respond in helpful ways. This booklet can help individuals find ways of expressing their experience and also help supporting professionals think in a more nuanced way about the issue.

Creative hobbies and work recovery

Recuperating, Revitalising, and Reaffirming: the experiences associated with creative hobbies, and their impact on recovery, wellbeing, and work by Delores Hill

This research project explored ways in which creative hobbies can support work recovery. This is a concept I often explore with health professionals I work with. It is the idea that what we do outside of work can help to replenish what is depleted by our experiences at work. It requires us to be attuned to our needs and be intentional about how we can support ourselves with what we invest our time in outside of work. Creative hobbies offer ways to meet a range of needs through supporting detachment from work, providing a sense of mastery, lifting our mood, and connection with values. This article describes Hill’s research in a very digestible way, and offers useful practical applications.

Creative Toolkit for palliative care professionals

Co-producing a ‘creative toolkit’ to support the mental health and wellbeing of palliative care professionals: a community case study By Marie A. Clancy, Caitlin R. Kight, Jessica Stein, Naome Glanville, Anthony C. Wilson, and Richard G. Kyle

This publication explores the growing pressures faced by professionals working in palliative care, particularly in the wake of COVID-19, and highlights how a culture of prioritising patient needs often leads staff to neglect their own wellbeing. It presents a co-produced, arts-based “Creative Toolkit” designed to support the physical, psychological, social, and spiritual health of staff through reflection, relaxation, and connection.

Drawing on a small-scale case study, the paper demonstrates how creative approaches can help staff process difficult experiences and build a sense of community, with highly positive participant feedback. While the findings are context-specific and further research is needed, the publication makes a valuable contribution by showing how creative, arts-based interventions can be meaningfully integrated into workforce wellbeing support.

Art therapy to reduce burnout

Art therapy to reduce burnout and mental distress in healthcare professionals in acute hospitals: a randomised controlled trial By Megan Tjasink, Catherine Elizabeth Carr, Paul Bassett, Gehan Soosaipillai, Dennis Ougrin, and Stefan Priebe

This study examines whether a brief, structured group art therapy programme can improve burnout and mental wellbeing among hospital-based healthcare professionals. In a large, multicentre randomised controlled trial involving NHS staff across a range of roles, participants were assigned either to six weekly art therapy sessions or to a wait-list control group receiving usual support.

The findings show that those who took part in the art therapy programme experienced significant reductions in emotional exhaustion, alongside improvements in stress, anxiety, depression, and detachment from work, with benefits sustained at three-month follow-up. While the study had some limitations, including its reliance on a wait-list control and limited subgroup analysis, it provides strong evidence that a relatively short, manualised and theory-informed art therapy intervention can meaningfully support staff wellbeing and could be integrated into hospital workforce support services. The lead author, Megan Tjasink has been a guest on the When Work Hurts podcast – you can listen to her talk about her work here.

The Body Hotel Self-Care Suite

The Body Hotel Self-Care Suite: Evaluation By Teresa Filipponi, Carolyn Wallace, and Thania Acarón

This publication evaluates The Body Hotel Self-Care Suite, a creative, movement- and body-based programme developed to support the wellbeing of palliative care staff within NHS Wales. Focusing on teams at Velindre NHS Trust, the study explores whether embodied, creative practices can enhance wellbeing, psychological safety, and day-to-day working relationships.

Drawing on interviews and pre- and post-programme questionnaire data, the evaluation found that participants reported increased energy, emotional resilience, self-awareness, confidence, and self-compassion, alongside a stronger sense of connection with colleagues. Staff also described applying tools from the programme to manage stress, communicate more openly, and foster more supportive team dynamics. While based on a small, self-selecting sample, the findings suggest that creative, body-based approaches can play a valuable role in supporting workforce mental health and cultivating more compassionate and sustainable workplace cultures.

It’s clear that the arts and creative practice can play an important role in supporting the wellbeing of healthcare staff. Creativity & Wellbeing Week is coming up (18th – 24th May 2026) – this is a great opportunity to consider how you might be able to bring more creativity into your workplace and life.

On 19th May I am running an online workshop for doctors with Dr Alison Smith of Earth & Bloom called Shaping Self Compassion. It’s a hands on workshop using clay to explore and nurture compassion for yourself, something many of us in helping professions struggle to access. It will be a gentle evening combining the soothing and tactile experience of working with clay and other natural materials with a listening circle. Booking closes on 5th May (to give us time to get your goodie bag to you), so secure your place today!

The post Creative health and wellbeing for healthcare staff: a research roundup appeared first on Dr Paula Redmond, Clinical Psychologist.

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Full transcript below

In this episode Dr Paula Redmond speaks with a team of colleagues in Wales about their groundbreaking and award-winning work on avoidable employee harm within NHS complaint and disciplinary processes.

Working at the intersection of psychology, HR, and healthcare quality improvement Benna Waites, Dr Adrian Neal, and Andrew Cooper highlight the wide-ranging psychological and systemic impacts of complaints processes, not only for the staff under investigation and their teams, but also for the managers and HR professionals handling these cases.

They discuss interventions and initiatives designed to reduce harm and promote psychological safety in this arena, with meaningful impact at both operational and policy levels.

This episode shines a light on what it takes to build cultures of care within organisations, where accountability and compassion can coexist — and how clinical psychologists can bring something unique to organisational systems change.

About the speakers:

Benna Waites: Consultant Clinical Psychologist, Joint Professional Lead for Psychology, Counselling and Arts Therapies for Aneurin Bevan University Health Board (co-leading around 300 staff). Programme Director for Leading People – a successful in house intensive leadership development programme currently celebrating its 10th year. Seconded part time in the national improvement team in NHS Wales and chaired the national Psychology for Improvement project funded by the Health Foundation’s q Community. Co-founder of http://compassionpractices.net – set up during the pandemic to make compassion practices – a highly structured conversation to support compassion in groups of staff – freely available.

Dr Adrian Neal: Consultant Clinical Psychologist / Head of Employee Wellbeing Service, Aneurin Bevan University Health Board

Andrew Cooper: Head of Programmes for Employee Wellbeing, Aneurin Bevan University Health Board

Resources

• New book out November 2025: Bristol University Press | Under Investigation – Transforming Disciplinary Practice in the Workplace

• The Avoiding Harm programme by the HPMA – www.hpma.org.uk/avoiding-harm

• Paper on harm to investigators: Understanding the Impact of Employee Investigations on Those Who Lead Them: A Case Study from NHS Wales

• www.compassionpractices.net

• https://www.linkedin.com/feed/update/urn:li:activity:7364310949052219394

I’d love to connect with you so do come and find me on LinkedIn or at my website and do check out the ACP-UK and everything it has to offer.

Follow and subscribe so you don’t miss an episode!

Transcript

Paula Redmond (00:04)

Hi, I’m Dr Paula Redmond and you’re listening to the When Work Hurts podcast, which is brought to you by the Association of Clinical Psychologists, the representative professional body for clinical psychologists in the UK. In this series, I’ll be covering the difficult topic of surviving formal complaints, particularly for psychologists. I’ll be bringing you conversations with brilliant guests, offering their expertise, experience and wisdom on this tough topic from a range of different perspectives.

This is the final episode in this series. I’ve learned a lot doing this and I hope it’s been helpful for you, whether you faced a complaint yourself, supported someone who has, or just want to be more informed and prepared, should it be something that crops up for you in the future. I’ve covered a range of angles, looking at the research evidence around the impact of complaints on psychologists, understanding the practicalities of HCPC fitness to practice complaints and how best to navigate these, and hearing directly from those who’ve been through this. To finish off the series, I wanted to zoom out again, broadening the discussion to complaints in the NHS more generally and the organisational and systemic issues related to this. To explore this, I spoke with a team of colleagues in Wales about their groundbreaking and award-winning work on avoidable employee harm within NHS complaint and disciplinary processes. Working at the intersection of psychology, HR and healthcare quality improvement, Benna Waites, Dr Adrian Neal and Andrew Cooper share their insights into the wide ranging psychological and systemic impacts of these processes, not just for the staff under investigation, but also for the managers and HR professionals involved. We talk about the interventions and initiatives they’ve developed to reduce harm and promote psychological safety in this field and how their work is influencing change at both operational and policy levels. Please do check out the show notes for links to some really helpful resources, including their brand new book, ‘Under Investigation, Transforming Disciplinary Practice in the Workplace’. We kicked off the conversation with introductions.

Benna Waites (02:26)

So I’m Bena Waits, I’m a consultant clinical psychologist by background. I’m professional lead for psychology, counseling and arts therapies in an Aneurin Bevan University Health Board. And I also run a leadership program along with Adrian and Andrew in Aneurin Bevan.

Paula Redmond (02:44)

Brilliant, thank you. And Adrian?

Adrian Neal (02:47)

I am a consultant in psych. I guess the day job is head of employee wellbeing for an Aneurin Bevan University Health Board. Yeah, been doing that for about 10 years. But work closely with Benna and Andrew across a number of projects. I think that the leadership programme and the avoidable harm are the two key preventative focused projects we’re working on and have been doing for quite a while now.

Paula Redmond (03:13)

And Andrew?

Andrew Cooper (03:14)

Well, hi, my name’s Andrew Cooper. I joined Aneurin Bevan Health Board about three or four years ago to develop the Available Employee Harm Program with a particular focus on the application of the disciplinary policy and process. And it’s been great working with Adrian and Benna over this time to develop this as really trying to make a difference and perhaps a gear change in how we do things.

Paula Redmond (03:39)

Great. And maybe we could start actually with just defining what avoidable employee harm is. I don’t know who would like to just say a bit about how you understand that concept.

Andrew Cooper (03:51)

So we developed the avoidable employee harm concept, really drawing lessons from the patient safety movements. And the patient safety movement established around 40 to 50 years ago, recognised that actually they were causing harm to patients, the healthcare professionals around the world, recognised that they were causing unintended harm, but also avoidable harm. And the recognition grew that there was no negligence or malice, that it was actually down to working in complex systems, that healthcare is complex. We work in systems that involve multiple layers, multiple people, multiple groups and interactions. And it is within all those interactions that sometimes harm takes place. And the patient safety movement started by recognising the potential and the possibility for harm, and then started identifying areas where harm was most prevalent. And then when they were identified to develop an interventions to address them. So that really underpinned our thinking for avoidable employee harm, reflecting on one of some of the things that we do, perhaps through our processes and our policy application that causes avoidable harm to our staff. So we’re a bit behind on the patient safety movement, but just starting that conversation around, are there things that we do that causes harm that can be avoided?

Paula Redmond (05:20)

And I guess the question to kind of all three of you about what it is that brought you to this work, Benna, shall we start with you?

Benna Waites (05:29)

So I think over many years as a professional lead, I had noticed the enormous impact both on colleagues from within my own service, but also peers and colleagues from elsewhere, the huge impact that investigations and complaints had on people. And often, because in a sense, it’s a process you work your way through, but the emotional impact felt enormous for people. And often these were very long and drawn out processes. So over many, many months, sometimes well over a year, you would see people and the ramifications and the ripple effect in their lives were huge. So it had been around for me for a long time, that sense of this really doesn’t feel okay. And is there a better way of doing this? And could we approach this differently? Could we think about it differently?

Paula Redmond (06:22)

Brilliant, thanks Benna. What about you, Adrian?

Adrian Neal (06:25)

So I guess acute reds. I, career wise, about 15 years or so, I started moving from a more traditional adult mental health role into staff work, did an organisational psychology masters and then kind of moved sideways. One of the, I guess one of the things I got interested in back then was the impact of organisational processes. Not so much disciplinaries or complaints process, but more organisational change on staff, first-hand experience, and a kind of very prolonged, uncomfortable, fairly miserable experience led me to develop that interest even further, but also leave the job I was in. So that was the kind of the driver personally. Landing in a new job, I guess, one of the things as a head of an employee wellbeing service for years and years, a kind of dominant core business was supporting people going through processes like this and others. But, so it’s not just my reflection on that, but my, you the entire team, the clinicians and the team feeling like this was a very tricky area because therapeutically, it’s actually very challenging to work with somebody caught up in a process, bit like a legal process, recovery tends not to really happen until it’s finished. And then there’s the whole wider systemic ripple effect, which you don’t tend to see in external legal processes, but you definitely see internally when it affects systems and departments and function and ultimately patients care. So for me, on the radar was always it’d be really helpful to do something in that area. And I do also remember a conversation with a senior psychologist not long after I’d started doing some support for a team and they were saying, can you do something about this? And at the point I was thinking, yeah, that’d be great. But no idea. You know, little seeds along the route, you know, and I guess from a wellbeing perspective, the Holy grail is prevention. We know it’s damn near impossible, but we know if you can do something systemically and you can make it proactive or preventative, the benefits are huge. So all of these things back in my mind, and then I can’t remember the timeline, but certainly kind of five years ago or so, meeting Andrew and with Benna, a conversation developed around, could we do something in this space? What could we, what could we do? And for us, that was the kind of beginning of the piece of work which we’re now talking on.

Paula Redmond (09:08)

And Andrew, what about you?

Andrew Cooper (09:09)

So my background is a little different. I’ve spent probably 10, 20 years in marketing and communications. And actually, how do you tell the story of change? How do you understand impact? How do you turn Benna’s description of what’s happened to somebody through a process, into something that’s relatable, understandable, and that can drive change? I’ve also been involved with the patient safety movement within Wales that recognised the harm that sometimes our treatments can do to patients. And I guess it was the conversation that the three of us had around, is there anything that we can draw from that learning and insight into how processes are applied? So a key part of patient safety movements has been a focus on quality improvement. How do we understand why things go wrong? And in understanding them, how do we develop new ways that can be tested to see if they’re tested and they test well, that they can be built into process and scaled up? So I guess bringing some of that insight into that wider conversation of how these processes were impacting people was really the start of this piece of work. And we use the term avoidable employee harm as a bridge between the two. We work in healthcare. Our healthcare colleagues understand the concept of avoidable patient harm. How do we take our non-clinical colleagues involved in management and administration and HR on a similar journey that actually acknowledges unintentionally often our processes can cause harm. So what can we do to mitigate or change that?

Paula Redmond (11:03)

Sounds like you guys are a dream team with your range of skills and expertise. So, Adrian, maybe I could ask you, thinking about the work that you’ve been doing in this programme, and I guess you’ve all mentioned the impact that these processes can have. I wonder if you could give us some more detail around that. What have you noticed in terms of the impacts of disciplinary and complaints processes?

Adrian Neal (11:30)

I mean, we published a paper about three years ago, I think, which we use as a case study that was reviewed by… or part of the paper was a kind of case study review methodology, so with multiple professional perspectives on a case. You know, that paper outlined a whole range of different scopes of impact. So we, you know, there is the obvious, and saying obvious, it’s obvious to us, but actually still not obvious, about the individual impact. We know that, and I think it doesn’t, given our audience, won’t take too much imagination to kind of appreciate the individual impact, whether it’s, you know, someone’s impact on their level of anxiety through to, you know, career changing decisions, you know, and lasting psychosocial scars. So I think we know that. I guess what we also discovered is a whole wider range of impacts, most of which are undocumented. There’s minimal literature out there. So we know that this causes a kind of cascade. So we often use the metaphor, it’s like dropping a pebble in a pond, but we’re only really focused on one angle, which is the individual. There’s a direct ripple into a team, into a system, be that because of disruption to usually tight knit teams, distribution of workloads, simply by virtue of somebody not being present and nobody being able to talk about it. So things like that, really difficult for teams. Anxiety and fear across team members who then think, you know, what bearing does this have on them? Suspicion and paranoia, you know, quickly follow because people don’t know what to say or do. So we know this really wreaks havoc with teams. We also know that people often go off sick either because they are simply not functioning and therefore not safe to work or as a means of getting some control over what little they have. So we know that impacts on capacity to deliver care. And that then ripples out in terms of a wider social, economic and financial cost. I guess more recently we’ve looked at the impact of people doing the investigation. So we know that even hardened HR and managers will, there will be, which kind of is a bit of a kind of, you know, d’oh moment, of course they’ll be affected because this is a distressing, they’re exposed to the distress of others. But we also know that people develop ways of coping with that over time. But we know that even hardened professionals struggle with this stuff and how they cope often doesn’t help. They will often cope in ways we know. People will seal over, will harden. It doesn’t make them better, having done this for years. But of course, that professional group has no history or tradition of psychosocial resources to support them. So they are pretty vulnerable, frankly. And you could argue, therefore, vulnerable to making mistakes. So that’s another area we’ve noticed. We know that it affects the person who’s being investigated’s family. That’s often not accounted for. So there’s this wider kind of arc of impact that happens once you start asking the questions. And what we were surprised with when we started doing this research is there’s very little out there. A kind of rapid evidence review a couple of years back, and it’s really poor. There’s nothing out there and it’s not consistent and it’s not great quality. So this is a, wow, this really is, if the patient safety movement is kind of 40, 50 years in its evolution and things are still happening, you know, errors are still being made. People’s relationship to accepting errors and embracing learning is still very much alive in the patient focused areas. We are way behind, in the human process is just so… you know, parts of our businesses. So yeah, lots of work there.

Paula Redmond (15:37)

Yeah, I can really relate to all of that you’re saying, Adrian. And I mentioned before we started recording, but I was part of a disciplinary process when I was working in the NHS as a witness, supporting witness. And it was for sure the worst, absolute worst professional experience of my life. And definitely one of the worst, you know, top 10 of my life, you know, and still those psychosocial scars that, you know, are still still present for me and just as being a witness as part of that. So I can for sure, yeah, relate to that. Was it Benna, was there anything you wanted to add?

Benna Waites (16:15)

I think in relation to the individual impact, although I think that’s easier to see, I think historically we’ve massively underestimated that, underestimated the harm. So purely at that level, just to be clear that the harm, as Adrian was saying, goes across multiple systems and areas of life. So kind of professional, reputational, financial, physical health, mental health, social life, family life. So it sort of spreads out across all of those systems, but also just the extent of it. I think what became increasingly apparent to us as we started sharing our experiences of being alongside people in this work, that sense that people are really traumatised. I mean, you can do an impact of event scale and you can score really high for PTSD as a result of going through a process like this. And that’s important. You know, I don’t think that’s widely understood by HR colleagues that there are those kind of costs and they last, they don’t stop when the investigation stops. They can last for years and years afterwards. So I think it’s just really important. And I suppose that that leads us into the work around how we might avoid that. But I guess really important to understand that when you embark on those kind of processes, and sometimes they’re unavoidable, sometimes there’s nothing you can do about embarking on the process, so a complaint will be, a patient complaint would be a good example of that, although I think you can be thoughtful at the beginning of that. But in terms of our internal disciplinary grievance, those kinds of processes, those are the areas where we need to be really careful about what our first steps are and what we think an appropriate response is to a set of concerns or difficulties or challenges, because I think we get it wrong all the time.

Andrew Cooper (18:12)

I think to pick up as well in terms of Adrian’s comment, in terms of the impacts on the investigator, that actually when we started this, was very much as Benna’s just set out, the individual who was the centre of the investigation, that’s where the red flags emerged, that’s where the concern was. But as we’ve developed this work and taken hundreds of HR colleagues and managers through our training, almost every training event, somebody will come up to me or one of us and say, I’ve actually been harmed by this process myself in terms of in that investigator role. And we’ve really looked to understand and explore that a bit more. What does that look like? Where is the harm? And just recognising that investigators are often carrying the workload of an investigation alongside all their other commitments. There is not enough space created for them to do it. The level and the information that’s being shared with them can often be distressing. They often see the impact of the investigation lived out on a daily basis of the person they’re taking through the process. So all those elements add up to a real sense of impact on the investigator. The paper we had published recently actually highlighted that no matter how many investigations an investigator does, it still doesn’t equip them to mitigate the harm to the person going through the process all themselves. So you actually, you bring that into consideration, and I guess we spent increasing time there because if there are to be improvement, it is about understanding that impact. Because I think there is a real sense that if an investigator, the more investigations they do, there’s the real potential for desensitisation because what they are presented with is so traumatic themselves and in a sense, how do they manage and regulate themselves in that space? And then I guess if desensitisation is one of the outcomes, that can quickly lead to compassion fatigue. So we believe a good investigation is absolute diligence to process, process is there for a reason, but also managing the wellbeing of the individual being taken through it. And there’s real concern that actually if we don’t look after our investigators, if we don’t create a sense of an opportunity for them to debrief, to understand what they’ve gone through, then actually it’s going to be a downward spiral in terms of subsequent investigations that are taken forward. And I guess for us that was one of the big learning points that wasn’t even on our radar when we started this work.

Paula Redmond (21:11)

Thank you. So I wonder, maybe if you could talk us through the work that you have done and what changes you’ve sought to make and how that has unfolded?

Andrew Cooper (21:21)

So we’ve taken a quality improvement focus with this work. And one of the key things within quality improvement is to look at the data. What is your data telling you? And our HR team conducted a review of investigations that had taken place over a 15-month period and discovered that of the 109 that had been undertaken, over 50 % of those had led to no sanction. So we were putting individuals through a process that we increasingly knew to be harmful, where actually looking at that data, perhaps they could have been taken through a more informal process, which would have addressed issues without the related trauma that we’ve been experiencing. Second element around quality improvement is to look at what interventions that we need to build to bring about change. And our HR colleagues have done an amazing piece of work within this space. They actually looked at what they call their initial assessment document. So that was a document that managers use to summarise the issues that might lead to an investigation. And they realised that in an earlier version that they weren’t collecting all the right information. They were collecting the information related to the issue, but perhaps not the wider context issue. So what was going on in the organisation at the time, who was the person sitting before them? What was their record like? Was their PDR and training up to date? So I actually looked at how do we improve that decision-making document that would consider those mitigations and not just focus on the issue. And then again, HR colleagues have done a job around coaching managers to help them understand the options for addressing workplace issues. Some managers had said to us, well, we thought the disciplinary policy was the only policy to pursue. And we actually were able to highlight, no, there’s less formal ones that they can pursue and also help managers understand what are the mitigations that might lead to making a different decision. So I guess there’s data, there’s building interventions, and it’s working with colleagues in the system who are responsible for making those changes and also helping them understand why those changes need to be made.

Adrian Neal (23:54)

And if I could just come in there, I think there’s a bit of context as well, which is helpful to frame what Andrew has just explained. So I’m sure Andrew wouldn’t disagree, one of the reasons we’ve been able to do this work, certainly because there was internal interest from HR in being curious about the numbers and the disproportionate amount of numbers and certainly the outcomes. But actually, even before that, what we had is we’ve had kind of the work authorised by the director of workforce. And actually, we started to develop the ideas with the previous director, who then retired and was replaced, and luckily, we had continuity of support, which has only grown. But a key area of support was an acknowledgement, and I still kind of think this was a key point. So my manager, the director of workforce, a kind of career HR, operations HR professional said to both Andrew and I, you know, I, this is uncomfortable, this idea, but I recognise it and I’ve done it. And that still is a really important moment, I think, in giving us permission to proceed, that recognition of the discomfort the profession has. And we can come back to that point later, I think, as we’re looking at it, you what’s turning into us, into a bigger culture piece beyond our organisation, but was a kind of cornerstone moment where a senior professional in a NHS role, which is highly politicised, Wales is very political, said, yeah, this is a problem and it’s uncomfortable. And to me that helped us immensely because each, as we, as you know, every colleague we talk to now, I think has their own moment of discomfort around this. And that’s pivotal for change. But centrally it authorised us to do this work within our organisation because, and I also think you know if we if we’d started this conversation a couple years before it wouldn’t have got off the ground, so there was something about timing and the right people were opening the right doors to allow this to happen.

Paula Redmond (26:06)

Benna, I know that you’ve got a particular kind of interest around psychological safety in particular and I wonder what that brings to this work?

Benna Waites (26:15)

Yeah, so I do. I’ve been teaching psychological safety on our leadership program along with Adrian for 10 years. And I now appear to be doing a PhD in psychological safety with all that spare time that I have, but it’s a real interest of mine. I guess part of the reason it’s of such interest to me is that I think in health teams that I see around me, it’s an enormous problem. There are lots of structural issues that make getting a climate where people can really have a voice and people can speak and raise concerns and ideas and feel connected, it feels a real challenge to make that happen. And of course, what we’re talking about, so engaging in formal processes, will make that so much worse. It will have a huge impact on not just the person and their voice and their ability to feel safe in that team, but also on colleagues and it’s really interesting you saying earlier Paula that you’ve had an experience of being part of an investigation. So often these investigations involve interviewing multiple, sometimes tens and tens of people to gather witness evidence. And that whole, that paradigm really of investigation, which feels for most of us, I think in our heads belongs more in a kind of criminal type context sets up, it is a massive counter influence to anything that would support and generate psychological safety. So it can be really challenging. I think if an investigation were done incredibly well and held really well and supported really well, you might be able to create enough safety for people to feel that they’ve said the things they need to say. I think it is not impossible that those two things can’t go together. But most of the time, I think the experience of it will be that it is suppressing of voice. And what we know about psychological safety is that when you lose voice, you lose team functioning, your teams just don’t function so well, your performance goes down, all the outcomes that you want, patient care suffers, all of the outcomes you want to see in healthcare get worse when psychological safety is damaged.

Paula Redmond (28:35)

I think it’s also, I mean, my experience was one of, you know, sometimes it was scary, like really scary in lots of ways, in ways that I never expected that it would be. And that thing of, as you say, feeling like you’re part of some kind of criminal investigation, but you have to go to work every day and be with people and just the impact of, you know, you want to avoid maybe conversations because it’s awful, you know, patient conversations, because to go and be in a room with people and all this stuff is going on and, you know, we don’t know who knows what and what, you know, it’s just, yeah, really horrible.

Benna Waites (29:16)

Yes, really, really messy and, and difficult. And so often I think a lot of these processes emerge in environments where there’s… that are interpersonally very complex. There’s a lot of dynamics flying around and often lots of claims and counterclaims. And I think we really need to ask ourselves, you know what, if we recognise that, what is the best way of addressing and supporting? And I think there is value sometimes in bringing external support and external eyes on the challenges that teams are having, but whether those external eyes should be coming with their sort of tick box investigation kind of lots of questions, sort of gathering evidence, whether it should look like that, I think is really questionable.

Paula Redmond (30:03)

And what are the other things that you have sought to change in this work? Things that you haven’t mentioned yet?

Andrew Cooper (30:11)

One of things that we’ve been doing within NHS Wales, so within NHS Wales we’ve got a once for Wales policy approach, so the NHS Wales disciplinary policy is for every organisation within NHS Wales and about two years ago we started a journey to review it, but also for it to be informed by this work, by this research, by the insights that we were drawing. Interesting that Adrian talked about a piece of research that we did where as part of this disciplinary review, we didn’t want to just tweak the policy, we actually wanted to understand what does good policy look like in this space, you know, what does good process look like, what does textbook approach to run disciplinaries look like. So we undertook a rapid evidence review of key HR literature. And as Adrian mentioned, there is so very little out there. And if you pause and reflect and think, actually, we are running thousands of investigations every day around the world, and yet there is very little evidence that suggests what good looks like, I think it’s a real challenge to the profession, but also to all of us involved in either supporting or running investigations. And that curiosity and that need to try and identify the best way of doing things is really critical to this work. I guess, because we’re so linked and connected to healthcare, we know that if there’s a healthcare issue that arises very quickly, we’ll have academic colleagues around the world taking it apart, seeking to understand it, testing medical interventions to address it. And yet we don’t have that same approach for processes that seismically can impact populations. And then actually that’s the journey that we’re on at the moment is, whilst we started with very much an individual impact, how do we understand policy design, policy development, policy implementation to actually improve this? And I guess one of the things that we’ve looked at is how do we support the individual going through it better? Because actually that’s good for them, but it’s also good for the investigation. Actually, if we looked at the investigation more positively and said, this is an opportunity to perhaps improve or correct something about how our organisation operates, then we also see the person being investigated as part of that solution, and actually taking them on that journey, looking after them, ensuring a really good duty of care should be an equal part of that process. When Benna was talking, I was reminded of Deming who said, a bad system will break a good person every time. And that actually, you know, you replace that word, a bad process will break a good person every time. And whereas perhaps a couple of years ago we were thinking that person who’s broken is the person at the centre of it, the list is growing in terms of, and Paula you’ve identified that, the list is growing of the people that will be harmed and broken by it. So it is very much how do we step back and really understand how to deliver these things better.

Adrian Neal (33:52)

Just to build on Andrew’s contribution. So I think there’s a pivotal idea here, which I think threads through so much of how the NHS as a kind of massive bureaucracy operates and how it responds to individuals versus system factors. So one is from a, I guess a quality improvement or just a systems learning process. We know we’re not very good at learning. Why is that? Every inquiry kind of repeats the same thing. So how, why do we struggle with learning? But also, so to me, one of the harms is failure to, each of these investigations, unless you really understand the systemic factors that have contributed, of which it’s more than likely to have contributed some way because of the complex nature of our work and also the kind of interactive multilayeredness of how most people work, you never find out actually why this thing happened. Whether it’s a complaint, the cause of the complaint or whatever, why the relationship broke down. So it never gets really reviewed and repaired. We just kind of amble on. But as part of that kind of, maintaining that process, which I’ve always been uncomfortable with because it is just a massive waste, but the airline industry’s going yeah, it’s the pilot again, just sack them and let’s move on. We need to know why, whether it’s a drug error, whether it’s complained about, you know, alleged poor care, there’s always going to be more than an individual involved. In our leadership program, we have a colleague who’s influenced us all quite a bit, but his kind of model of leadership is a systems leadership approach. And he tends to say, look, most people are not mad, bad or stupid. So why do we keep blaming the individual? I think certainly in the NHS, a lot of the process is designed to target individuals. I don’t think it’s intentional either. I think it’s just culturally, habitually, how these processes end up. But it’s also the same from a wellbeing point of view. We know up until fairly recently, it’s really just been, well if somebody needs some wellbeing support for the individual, that’s possible. I mean, even now that’s questionable because of cutbacks. But the support for individuals is much stronger than support for systems or the ability of systems to learn. Burnout is a system problem. So all of these things. So we’re working within the space of trying to shift things away from the individual to support learning. And it’s going to certainly outlive me. But this is why we think this is the beginning of this journey. There are layers of relevance, I think, that take us into other motivations. But certainly one is this big idea about trying to create work, trying to create an optimal environment in work. And this is certainly, you know, it touches on psych safety, it touches on our capacity to learn, it touches on systems being able to understand people’s needs, as we would want to understand patient needs. And we’re still getting that wrong sometimes. So I think we are definitely very early days, but it’s very exciting.

Paula Redmond (37:07)

And what have some of the outcomes been? Benna, maybe you can…

Benna Waites (37:10)

Yeah, so a couple of areas where I’d say some quite concrete things have happened. So one of the things that was really clear to us exploring experiences of being investigated is that predictability is a really significant factor. So we know, and it’s basic undergraduate psychology, that predictability and control are the two kind of key mitigators really for stress and in fact social supports, and of course we know that people, because of the shame that often goes along with investigations and the requirement not to talk to any of your work colleagues. So very often people are absolutely deprived of social support. They’ve lost all control. The one thing that potentially if you’re going through a process like this, you could hang on to is predictability if you did what you said you were going to do. And what we’ve noticed is that so often these processes are set up with entirely unrealistic time expectations, and people don’t deliver and they don’t do what they say they’re going to do. And that’s often because investigators are overwhelmingly busy and have got loads of other things going on, but understanding the impact that that has on the individual. So Andrew, Adrian, I don’t know if you want to talk more about the guide, but it feels if the guide that we’ve put together for HR professionals leading these kinds of investigations and also for people undergoing them, is a kind of helpful just building that sense of the understanding of the process, trying to make it a bit more predictable, trying to mitigate a little bit if you are in a position of having to go through it. So I don’t know if you, Andrew and Adrian, if you want to pick that up and say a bit more about the guide.

Andrew Cooper (38:55)

So as part of the review of the disciplinary policy, we actually wanted to think about how do we support individuals better going through the process. And as Benna has mentioned in terms of predictability, it’s a key thing that often colleagues report after meetings changed, being advised that they’ll get an outcome on one date and then it gets cancelled and dropped. And each one of those experiences, whilst might be an administration factor for the individual leading the investigation, for the individual going through it they are crushing blows each time, because actually they are living their lives waiting for feedback. So we worked with HR colleagues, wellbeing and occupational health colleagues to identify what were the top 25 questions that people ask when they are being taken through an investigation process. So we looked at them on multiple levels. They could be questions like, am I going to be paid while I’m taken through this process? When you say I can’t talk to anybody, do you really mean I can’t talk to anybody? When this is over, what about when I come back to work? What does that look like? What will it feel like? And I guess what we were looking to do is that if we could provide answers to some of those fairly straightforward questions, it could minimise or mitigate some of the anxiety. It was never going to remove all of it, and you could argue to how much it removes, but actually we had a sense that it could manage some of that anxiety. So the aim is when we launch our policy, that that guide will be issued to everyone who receives the letter telling them that they are now the subject of an investigation, here’s the policy, but here’s the guide to help you through it. Because in terms of the process, and Benna would be able to kind of advise more on this, but we know that an individual’s cognitive ability is reduced during times of stress and anxiety. So their ability to read a complex document like a disciplinary policy becomes even more challenging. And again, the reason that we wrote this guide, we took the model of a patient information leaflet that recognises that when a patient receives a diagnosis, they often remember very little of what the healthcare specialist has said to them, and that’s where a guide might come in from, like Macmillan Nurses to say, these are some of the questions you might have. And again, it feeds back into that piece of, we want the person to be in the best place they can be for themselves, but also to contribute to the investigation process well.

Adrian Neal (41:53)

Just to add and correct me if I’m wrong, Andrew, but you, didn’t you do a piece of work looking at the reading age of the previous policy and what was the reading age?

Andrew Cooper (42:04)

So as part of the review of the process, we had the current disciplinary policy reviewed and were told that actually you had to be at a graduate level reading age in order to make sense of the policy. And as I’ve mentioned in terms of cognitive ability, that is significantly reduced when we feel stressed and anxious. So in one sense, the policy wasn’t necessarily the best document to help somebody through the process, which is where the guide came in.

Adrian Neal (42:34)

So even in how we convey these ideas, be it formal policy, right down to individual letters, think that it’s all, you can create interventions at multiple levels. And often you need to, because it’s kind of the failure to understand how people process information is just, it’s endemic. But I’m pleased to say that at least within, well, we know that within Aneurin Bevan, and within a number of organisations we’ve worked with, they’ve looked at that set of very tangible things they can change. But the guide is, I think, is a key piece of work, just to help mitigate that sense of lost control and kind of social distress around this thing is happening to me. But only mitigate, can’t remove those things you need to look at.

Paula Redmond (43:25)

And Benna, I know you’ve been, one of the things that’s been important for you in the work is thinking about suspension in these processes?

Benna Waites (43:31)

Yes, there’s often a presumption, I think, in these processes to suspend. Often that’s kind of part of the process that you follow. So a complaint’s received or a process is initiated, and the assumption is that you suspend, and to send somebody home. And I’ve seen that happen so many times. And I think what really struck me about that was it feels really punitive. It feels as if it increases the impact because suddenly we know don’t we the impact of unemployment for example on mental health, we know it’s pretty catastrophic for your mental health to lose all structure but to lose all structure at a time when your whole professional identity, your work life, your financial security, when lots of things feel like they’re on the line that’s really hard to do that. I think there are times when, because the interpersonal dynamics are so enormously complex, that it’s better for everybody, including the person at the centre of the process, to be removed. But there are options around finding other places and other opportunities and other ways of working, really. So I guess there’s something about fighting the presumption to suspend. But what I’ve noticed when I’ve been involved in those processes, is how hard I’ve had to fight, you know, and even now, you know, even relatively recently in our organisation, it feels as if that’s still, I think it’s almost baked into HR training, that sense of, this is your starting point, just take everybody out of the situation because that will be better, it will be kinder. And it is messy. Paula, you talked earlier about that experience of being a witness and then having to have a conversation with somebody, those things are tricky. They’re really tricky, actually. And I think there are ways you can manage that. So it might be that, you know, somebody’s going through a process and there are bits of their job they continue to do, but you know, bits that they don’t, or as I say, you can shift them into a different role. But I think we shouldn’t underestimate the enormity of removing somebody’s occupational structure from their lives at a really stressful time. I just think it’s a very damaging thing to do.

Adrian Neal (45:50)

I completely agree. I guess the other, and Benna alluded to a little bit, I think there’s something about how, and this is possibly a healthcare professional specific, but probably not. I suspect other industries have the same thing, probably education. But in terms of people’s relationship with their work and their identity and their sense of who they are, their sense of self is often intertwined with their work and with their sense of purpose and those they work with. So I think what at one level might look like an operationally neat thing to do to remove the person from the stressor, it’s never neat and it’s never straightforward because often people’s working environment and their relationships with them is hugely protective. I think that can add a dimension which I think a lot of HR colleagues don’t get because they often haven’t been through it themselves, but also they may have a slightly different relationship with their work, although that may be unfair. So I think the, and if you, the more complex and messy the situation, often the simpler the solution is really, not a simple solution because of conflicts and the intense expressed emotions, but yeah, so the suspension idea is a fix is really flawed. This has to be an absolutely case by case decision. And I do worry that sometimes less experienced HR colleagues don’t feel confident enough to sit there in the fray and not make a reactive decision. I’ve certainly seen more experienced colleagues able to sit there and tolerate the not knowing and the pressures from different angles. Because again, our work is very politicised, isn’t it? We sit in, HR colleagues often sit in the middle of competing social groups, got pressures often from patient safety angle, legal pressures often. So it’s a hugely distressing position to be in. So being able to tolerate that, I think is key. And I pretty much guarantee nobody gets any training on how to do that if you’re an HR professional, whereas clinicians, psychologists might, but don’t always.

Paula Redmond (48:08)

Yeah, it’s a sort of that, I mean, it’s a literal exiling and shunning, isn’t it, of, which is such an absolute kind of primitive, and scary for the people left behind too, that someone can be ripped from their midst and we can’t know. And yeah, that’s really…

Andrew Cooper (48:27)

I think for me though, as we kind of talked about that impact of suspension and clearly a major one, but Adrian’s just touched on, just that difficult space for HR colleagues to inhabit. And I think I’ve certainly had an increase in appreciation for that. So in terms of where they are perhaps in their career, so often if you’ve got young HR professionals who have probably been trained and kind of driven into them, you follow the process, you follow the process. And because of that anxiety of kind of coming new into a profession, you do what you’re told. And it is only often seen with those colleagues who have more experience that perhaps understands the process better, perhaps have got some experience of how it’s impacted, and that they’ve got perhaps a greater sense of autonomy in order to question and challenge and kind of all within that context of an organisation’s appetite for risk, all around in terms of changes in legislation, you know, granting more rights to the employee and that’s right, but at the same time, it makes that pathway much more difficult to navigate. So, you know, certainly with this work, it’s been very much seeking to appreciate and understand what our HR colleagues and managers, because managers often don’t often feel confident to apply policy because they may not do it very often. And because they don’t do it very often, they become more rigid in their approach. And then how do you help a manager balance that focus on process and the person. So this journey has really been, actually, how do we appreciate, understand and take our HR colleagues and managers on this journey just because of the challenges that they face in doing it.

Benna Waites (50:34)

What you were saying, Andrew, reminded me that another area where I think we have quite a significant skills deficit in our organisation, in our healthcare systems generally, not just in our organisation, is around having difficult conversations. And what I notice is that that ability to be able to engage with tricky, difficult, interpersonal concerns is just not really present in our leaders within healthcare. So we’ve been running a having difficult conversations session on our leadership programme, and it’s consistently the one, or it’s consistently one of the ones that’s right up there, we cover a lot of material, but it’s consistently something that people come back to and say, oh, thank, that was so helpful, so useful to think about how I might frame it, think about how I might approach it. But I’ve noticed over the years when I’ve perhaps expressed concerns about some of the things going on in a team where perhaps I’ve done an exit interview with somebody and they’ve raised some informal concerns, they don’t particularly want them to go anywhere, but I’m kind of thinking this would be useful for a manager to kind of hold and think about, and think about how it might kind of shape their interactions with a particular individual. And I’ve often had a kind of rebuttal from managers saying, well no, if there’s no formal process, there’s nothing, there’s nothing I would expect to do about it. And that feels like a real problem. It’s like, this is such a missed opportunity. If we can be catching these things by having the more uncomfortable, the slightly more challenging, the slightly trickier conversations sooner. So that’s something that I think connects well to this issue of prevention too.

Adrian Neal (52:16)

Just picking up the management leadership pattern really, and I’m sure Andrew will agree, so they are, I think, the key group. We talk about HR colleagues, but actually the vast majority of people that will make the decision whether to proceed with a complaint or a professional conduct type of investigation will be the managers. I think management in the NHS is an interesting one in terms of capability, competence, but also how we design our systems. I think we can often, I say, I keep saying this as a generalisation, but often you find managers that are not supported, not educated, and then not developed in very influential roles with a lot more people than they can manage. If you think about how many, you know, what’s the ideal size of a team? We know, you know, Aston model would say, you know, 12 to 14. We regularly come across people in the leadership program, they have more than that, way more than that. And how can you be a manager in that kind of system? And if you get a complaint or something coming in, it suddenly takes up so much more of your time. You’re more likely to be more transactional about it because you just don’t have the capacity to deal with it. That’s even before the areas around difficult conversations, which is the upstream stuff that might help prevent these things happening. So I think that as a professional group is, I think we have a real problem, not because there are bad managers, but because how we go about supporting, developing is systematically problematic, because I think it’s an almost impossible job. You can skill, you can support. One of the things we noticed in our leadership program is that often, the cohorts will stay together as a resource for each other because they’re all struggling with similar things. So again, if you’re trying to influence people’s experience of complaints or grievances or the managers are pivotal. And I know there’s currently a GMB union push to accredit management looking at some sort of accountability mechanism. I can see the logic, but I’m not sure that’s the right tool, but I think the accountability is a major part of the problem, as well as the support and the development of that professional group, given that most health professionals are regulated up to the eyeballs, professional managers aren’t. And neither are HR colleagues for that matter. So it’s interesting. I think there is space in that area to think about that in a useful way, not in a punitive or kind of controlling way, but how do we quality control and support and develop those groups?

Andrew Cooper (55:06)

Last comment from me on it, but it picks up the psychological safety piece that Benna was talking about, that often when we work with managers and we ask why have you initiated a process? Then it’ll often be fear, because the fear of getting it wrong, or fear of not following process because actually this could impact on them. So that sense of around that cultural impact, how psychologically safe a manager feels within the organisation also determines the course of action and the way in which they will commission and lead an investigation.

Adrian Neal (55:48)

I couldn’t agree more.

Benna Waites (55:50)

Absolutely.

Paula Redmond (55:51)

Any other kind of key outcomes or challenges that you’ve faced?

Adrian Neal (55:57)

Definitely no challenges.

(Laughter)

Andrew Cooper (56:02.21)

I’d almost like to pull Benna in on this, but we’ve taken this quality improvement approach so that the focus has been for 30 months, two years, how do we improve the approach. But, Benna, we know with improvement, don’t we, that it needs to have that constant focus on it and as the priorities come in, staff change, and I guess it’s how we keep the focus on a major cultural change piece because we know things don’t change overnight. It needs years of a consistent approach to bring about that change. So I think that’s probably more of a longer term challenge, what we feel we’ve been able to do here is raise it as an issue, identify the related harms and impacts, develop an intervention that might address it. But the long-term challenge is how do we bring about sustained change and not slip back into old ways of practice or if that psychological safety within the organisation is not strong, how do we keep people on that journey of change? Benna, any thoughts?

Benna Waites (57:25)

Adrian’s got his hand up, so let’s go to him first.

Adrian Neal (57:29)

Lots of thoughts. So in me, I guess thinking aloud, there’s two spheres of work. There’s the operational sphere, which is about individual systems, looking in detail at how they deploy, run, evaluate and understand these processes and how they can be used internally to help improve learning and to kind of navigate some of these very real psychosocial challenges and minimize harm. So that  to me is one thing, just good business. At the other end, there’s the idea, and I think that’s slightly more linked to the cultural dimension, so the avoidable employee harm idea. So it’s interesting because I think you get dissonant, you get people who go, yeah, no, this is, I can’t not think of this idea now. And then you look at the data and they still, you know, there’s still problems. So I think there’s, how do you keep both alive? Because they’re not necessarily, they’re interconnected, they’re, and they’re both necessary. But one of the things I’m, and Andrew will know this, but I’m gonna say it out loud, I’m particularly proud of is the two pieces of work. One is the policy work, national policy work, because if you’re gonna get anything to stick, that’s the way to do it. And I think Andrew could definitely tell you how fun that’s been, but it’s gonna get over the line. And the second piece is another piece of work Andrew has been working on, but it’s to establish an avoidable employee harm award category within the HPMA UK. So the idea that it’s so legitimised now, a national organisation for the accreditation of healthcare management professionals has created an award. So the idea that is so valid now that that organisation is taking it forward at that level, I think will help keep it in people’s minds. So that I think will seed, but we also need that on the ground, operational changes. And that I think is… both are challenging, but both are moving. I’ll stop talking.

Paula Redmond (59:33)

Thank you. Benna?

Benna Waites (59:35)

So picking up on Andrew’s point about sustaining gains, I think that’s a real challenge. So we saw some really incredible results of this work being picked up early and a reduction in processes and of course, all of the kind of harm we avoided and all of the time we saved, which is fantastic. But trying to keep that as Andrew says, when you get change in personnel and shifts. So that sustaining your gains is an ongoing challenge, I think. The issue about how we design the culture, how we create a culture that will prevent or massively reduce these kind of processes, feels really important. And I think there’s lots to be done in relation to leadership, because leadership, I think, has such a huge impact on the climate in teams, but also on the way that we talk about our work, the way that we think about our work. So another… Adrian was referencing our colleague Ian McDonald earlier who works in systems leadership, but Ian would talk about what’s the work and I think that sense that the work of leaders, the work of teams is to create an interpersonal environment that is psychologically safe, that works for everybody in it, that enables concerns and difficulties and disagreements to be explored safely. That is a really key part of our work and I just don’t think we give it the air time. And I think I’m really interested and we have done less work on this, but I think we will do more. Andrew mentioned the kind of to-do list that we have and are working on, but something about the sort of postvention that kind of aftermath, the sort of return to work, the, you know, what happens afterwards. And that feels really important in terms of how you might restore connection and psychological safety after a process. So it feels like there are lots of challenges and opportunities around this work. It’s yeah, it’s just finding the time to do it all really. But yeah.

Paula Redmond (01:01:40)

And can I ask a question, I’m curious about the… Adrian and Benna have been clinical psychologists in this kind of space that’s fairly unusual for most psychologists to be working in this way. What do you think you bring sort of uniquely as clinical psychologists to this and how has that been received, particularly thinking about the HR kind of work?

Benna Waites (1:02:02)

So my sense is it’s been absolutely welcomed. I think it’s been really well received in the main. So I, you know, Andrew, you and I did a session, didn’t we, in North Wales, and I was really struck by how grateful people were. I think that discomfort that Adrian described earlier, that sense of discomfort about there is something wrong here, I think is really widely recognised. And so I think there is a real appreciation of people bringing, shining a light on that and trying to think constructively with people about it. I think we’ve tried really hard, we may not always succeed, to understand the context that these things happen in, the context for people’s training. So I think there’s a really deliberate effort not to be critical and not to be, but just to say, look, can we all think about doing this differently? So my sense is that broadly it’s been welcomed and I think that will be backed up by some of the awards, some of the acknowledgement, some of the kind of publicity that we’ve had in that world specifically of HR. So I, my sense, it reminds me a bit of across my career, often as a psychologist in a system that doesn’t have any psychology. So I’ve done a lot of work in physical health settings in the past. There’s such a thirst for what you bring. There is such a huge enthusiasm for that difference in your expertise and it’s often really welcomed. So that’s my sense about it but I am a bit prone to wearing rose tinted spectacles, so Adrian I don’t know if you want to slightly shift the perspective?

Adrian Neal (01:03:42)

So, yeah, don’t disagree with anything that Benna said. I guess for me, it’s a bit like, you know, if you’re a psychologist working in an area where there’s not many psychologists, that’s a privilege, but it’s also an interesting area. As Benna was talking, I was kind of thinking, do I see myself as a clin psych? I’m not sure I do. You know, I’ve been mostly influenced by organisational psychology for the last 10 years in terms of literature and evidence. But I guess I tend to, yeah, so I tend to introduce myself as a consultant psychologist because the consultant brand carries weight as a symbol in the NHS. So that’s intentional. I guess I also talk about myself as being the professional psychologist involved. And that’s, I guess, my way of saying I’m the one who’s qualified in here, in the space. And it’s, there is a personal bugbear in many ways, because I guess, we’re proliferated with pop psychology, aren’t we? And we know a lot of our colleagues in the workforce sector are very passionate and keen to understand psychology. Brilliant. But the people that can promote themselves in that space are not always credible, but social media is great at making yourself look great. So I tend to use those kind of monikers as, to authorise me to speak in that sphere. Yeah. I guess also using the doctor title is useful again, like consultant, it carries weight in the medical areas. It’s less useful in some areas, but I think that helps a system that responds to symbols and is hierarchical. So that can be useful. So yeah, just something.

Paula Redmond (01:05:28)

And Andrew, I wonder if you’ve got any observations of what that’s been like to have this clinical psychology or psychology kind of involved in this work?

Andrew Cooper (01:05:36)

So I expected more kickback from HR. I expected there to be a reluctance to engage with this. Actually, for the main part, colleagues have welcomed it. And I think that was a sense of their own discomfort with it. You know, those conversations that we have at our training. A senior colleague said to me quite recently, Andrew, if you’ve been in HR for any length of time, there will be things that you feel uncomfortable about. So what the psychology perspective I think has brought, I think has brought a number of things. First of all, that understanding of impact, impacts to the individual and impact as Adrian said on an organisational basis to the system. I think the discipline is much more curious around why do things go wrong? How can we do it differently? Has been incredibly helpful from that perspective. And certainly the way that we position this work and actually disciplinary processes need much more of the multidisciplinary approach to them that whereas they perhaps historically have sat within HR, actually, if we are going to take a more recent trauma informed approach, then we need HR managers, trade union representative, wellbeing, occupational health in the mix to be shaping the approach and making better decisions than we might have done in the past.

Paula Redmond (01:07:10)

It’s really exciting to hear that you’re doing this work because I guess that, I mean even just from a personal perspective, that people are attending to this and it’s having an impact is really good. So what’s next for this work? What’s coming up?

Andrew Cooper (01:07:24)

Well, we’ve been working within healthcare for the last two or three years, really seeking to understand the impact, looking at what interventions that we can develop and seeking to bring change, working with HR colleagues in this space. What’s been interesting, we’ve increasingly engaged with other sectors and we’ve talked to them about this work and generally the common response is we don’t have it right here either so that actually this isn’t an issue just for healthcare. I think if we think about that approach to understanding disciplinary policy and not really understanding what a good process looks like across these sectors. So we’ve been working, we’ve started to work with local authorities, we’ve got other sectors coming on board equally interested and then delighted that the three of us have been involved in a book that’s coming out later this year. The book’s called ‘Under Investigation, Transforming Disciplinary Practice in the Workplace’. And really the aim is to continue a conversation with HR colleagues, managers, organisations across sectors to see whether some of the journey we’ve been on, and certainly the journey others have been on in terms of making improvements in this place can be scaled up and make even greater impact, not only for individuals going through these processes, but also their organisations as well, so that it’s a better experience for work, but also organisations can deliver better outcomes as a result too.

Paula Redmond (01:09:01)

Well thank you so much guys, that’s been fantastic.

Thank you for listening. If you’ve enjoyed this episode, please support the podcast by sharing it with others, posting about it on social media, or leaving a rating or review. I’d love to connect with you, so do come find me on LinkedIn or at my website, and do check out ACP UK and everything it has to offer. All the links are in the show notes. Thanks again, and until next time, take good care.

The post Avoidable employee harm: Rethinking NHS complaint and disciplinary processes appeared first on Dr Paula Redmond, Clinical Psychologist.

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Full transcript below

Dr Paula Redmond speaks with two clinical psychologists — Caroline Taylor and Dr Amber Johnston — about their personal stories of receiving a fitness to practise complaint.

They discuss what it was like to go through the process, how it affected them personally and professionally, and what they’ve learned along the way. Together they reflect on themes of shame, fear, and isolation, but also on meaning-making, growth and the importance of support.

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About the speakers:

Caroline Taylor is a Clinical Psychologist in private practice. You can connect with her via Psychology Today or LinkedIn.

Dr Amber Johnston is a Consultant Clinical Psychologist and Neuropsychologist. She runs the Healthy Mind Psychology clinic. You can connect with her on Instagram or Linkedin.

I’d love to connect with you so do come and find me on LinkedIn or at my website and do check out the ACP-UK and everything it has to offer.

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Transcript

Paula Redmond (00:04)

Hi, I’m Dr Paula Redmond and you’re listening to the When Work Hurts podcast, which is brought to you by the Association of Clinical Psychologists, the representative professional body for clinical psychologists in the UK. In this series, I’ll be covering the difficult topic of surviving formal complaints, particularly for psychologists. I’ll be bringing you conversations with brilliant guests, offering their expertise, experience and wisdom on this tough topic from a range of different perspectives.

In this episode, I’m joined by two clinical psychologists, Dr Caroline Taylor and Dr Amber Johnston, to talk about their personal stories of going through a fitness to practice complaint. They speak openly about how it affected them, but also what they’ve learned through it and what they’d like others to know. I’m so grateful to Caroline and Amber for sharing their stories with such generosity and honesty. I hope this conversation will help others feel less alone and open up more compassionate discussion about complaints within our profession. We begin with Caroline’s story. 

Caroline Taylor (01:13)

My name is Caroline Taylor. I’m a clinical psychologist and I work in private practice now. I’ve been qualified for about 15 years and the complaint was about, well during COVID, so it was about three or four years ago, yeah. 

Paula Redmond (01:29)

Okay. And what… can you say a little bit about what the context of that was? We’re not going to go into detail for obvious reasons about the nature of the complaint and who was involved, but just to set the scene for us a little bit about the context of when you received that? 

Caroline Taylor (01:47)

Yeah. So I received the complaint in the late summer 2020, and I’d left the organisation where the complaint came from. So the complainant was a member of my team, the context of the complaint was we were in a very busy CMHT and we had a lot of the clinical leadership off sick and then absent and us not having a full team. And I was probably one of the most senior clinicians and there was a lot coming to me. And of course, when you’ve got a lot and you’re overwhelmed, then of course you’re gonna drop the ball. That’s just… just normal, right? So yes, so I actually left my job because of what had happened. So I was taking ownership of my part in a difficult situation by leaving the organisation which I, that was the of my NHS career really. So that’s, that was the first impact really of pre, that was pre complaint. Yes, so that was all very difficult because I really love CMHT work and I don’t feel able to work in that trust again because I think my reputation is completely damaged. So it’s quite difficult really. Yeah, so that’s the context. 

Paula Redmond (03:26)

So you had a sense that… I suppose it wasn’t a surprise maybe that the complaint came or was it? 

Caroline Taylor (03:36)

Actually it wasn’t really a surprise. Actually when I first left my role, I was sort of like expecting a phone… Like every time I came back from London working, I was sort of expecting a letter on the door mat. So then it passed and other things happened and then, you know, Covid happened and I sort of let go of that and then… and then it arrived by email, was just a casual email really, by something quite serious. It was the allegation. 

Paula Redmond (04:10)

And that was from the HCPC, you had an email?

Caroline Taylor (04:15)

Yeah. Yeah. A case handler from HCPC. But it says very little. It says very little. And then, so you, you know, you’re kind of, it could have been, it could have been about anything, you know, or everything like it was, yeah, it was just difficult. It’s just difficult, little small amount of information you don’t really know the gravity of what’s been said. 

Paula Redmond (04:38)

Does it tell you who made the complaint? Yeah, okay, so it’s sort of something like this person has made a complaint against you, but that’s about it.

Caroline Taylor (04:50)

Yes.

Paula Redmond (04:52)

And what was that like to receive? 

Caroline Taylor (04:56)

I mean, I was just gutted. I was just gutted. You know, I, actually I completely own what, that part of what, of why the complaint was there and like why it happened, like why, why there was a complaint. I suppose in a selfish way I was like, well, you know, I, I know I’ve given up my career in the NHS because of this, but you know, that doesn’t mean anything. You know, if someone’s concerned sufficiently about your ability to be a clinical psychologist, then it should be reviewed. So that’s, I didn’t have a problem, it was fine. It was a bit, I was gutted, but okay, let’s see what happens. But it was a long process. 

Paula Redmond (05:44)

Yeah, so how did that unfold? 

Caroline Taylor (05:46)

So, yeah, so I got the email through, and you don’t hear anything and I instruct, as I was in therapy actually at the time because of what, because of what led to the complaint, I was in therapy because of what led to the complaint and then and the complaint. So I talked to my therapist about it, my psychologist, and they said have you got a solicitor? You need to instruct a solicitor. I was like okay, which I hadn’t even thought of, so I instructed a solicitor and they were great. But then it’s just like radio silence for ages because what I was told by the solicitor is that, you know, don’t go poking around in it because they just want to, they didn’t say don’t go poking around in it, they said, you need to wait until they contact you, and that you just have to sit and wait. Because if you are trying to find out what’s going on, there’s a lot about your conduct during the procedure, during, so there’s a lot of conduct, there’s a lot of, because they’re looking for a pattern of behaviour, right? So that’s what they’re looking for. So you have to be really careful about your behaviour. Yeah, so I was really grateful for that, that psychologist telling me that. And I did that and I got a solicitor and the solicitor was absolutely fantastic. I also took some advice from somebody outside of the country who spoke, you know, I just needed somebody that was completely not anywhere near any of it from me. And they were very helpful in my thinking about, you know, where I dropped the ball. They were super helpful. Yeah. 

Paula Redmond (07:35)

So there’s two parts there. There’s this kind of the practicalities of how you respond, how you get through the complaints process, you know, what’s the right thing to do, but also an ongoing reflection about the nature of the complaint itself. What does it mean about you? How you kind of reconcile that. So it’s a lot to be holding. 

Caroline Taylor (07:58)

And that’s before the allegation comes. So you say you have this, you’re waiting, you know, so HCPC do their initial investigation. They say yes or no, it’s worth furthering. So they went to… I knew it would go. So then they’ve done their investigation and then you get the allegations. And of course, they are the worst things you could ever have said in the whole world. They’ve picked the worst, they’ve found the worst of you. Somehow they’ve found the worst of you. And then you get to doing your defense. 

Paula Redmond (08:46)

And how long did that take from getting your complaint to getting the allegations? 

Caroline Taylor (08:50)

So the complaint came in August 2020 and the allegations maybe came in June or July 2021. 

Paula Redmond (09:03)

Gosh, yeah. That’s a long time. 

Caroline Taylor (09:06)

Yeah. And then you do your submission and that takes quite a long time. Because you have to own everything, you have to own everything because otherwise you don’t learn. So, I have to own and reflect more than I had already. And then you’re running up to that submitting the 10,000 word document for your defence. And that’s another huge part of work, the labour, emotional labour, that you’re going through. I learned so much about myself. Of course, I didn’t want to learn a lot of it, but like I did, you know, it really, you know, I can’t say it was a bad… I can’t say in retrospect, I can’t say it was a bad experience overall. It was just not, it wasn’t, it could flow better and it could be quicker and it could be… because I just think there’s a lot of hanging around for people, not just the person with the allegations, for everybody. A lot. You know, people’s partners, people like the person who’s complaining, their partner, there’s a lot of people. 

Paula Redmond (10:25)

So you submitted your defence document and what happened after that? 

Caroline Taylor (10:35)

It’s really, you just wait a little while and then you get a letter through saying what they’ve decided. And so what they decided was that if these allegations were proven, it may count as misconduct. But my understanding was that there wasn’t a great deal of evidence. Well, looking at the 100 page bundle that came, the evidence, there wasn’t, it was a bit, it would have been potentially, I think, a bit word… my word against your word, like I think. So there wasn’t much data to back up the complaint, I think, basically. So it was no case to answer. There was no cace to answer. And the relief was extraordinary. And I didn’t quite know how much I was holding before it.

Paula Redmond (11:42)

And how long did that whole thing take to get to the no case to answer? 

Caroline Taylor (11:49)

Good six weeks, maybe more. Can’t really remember. Yeah it’s just a very long process for people being a lot. 

Paula Redmond (12:02)

Yes, so about 18 months altogether. And how… What was the impact when you look back, how did that all affect you? 

Caroline Taylor (12:12)

I mean there was quite… I was impacted quite significantly, I’d say. So yeah, I definitely had a couple of periods, so when the complaint was first raised and then when the allegations came through, I was in very much of a bad way for about three weeks at a time. It was three weeks, two lots of three. Yeah, I was not, yeah. It was very, very challenging. Yeah, I was very scared and very ashamed and very sad about it. 

Paula Redmond (12:48)

And you mentioned that you were in therapy and you had support from a solicitor. Was there any other support that you were able to tap into or access? 

Caroline Taylor (13:02)

No, but looking back, you know, I could, think, I think there was a lot more I could have tried to get some help. I could have tried to get some help from the British Psychological Society and I did have a quite extraordinary experience. I was working as a network therapist in an organisation and then as an employee at the same organisation. And they’d asked me to apply even though they asked me to apply for a job, even though they knew that I was under investigation. And I did have extraordinary, unyielding support from them, which was amazing. But it was also a huge amount of work for my line manager to be writing a lot of things about me. Then, you know, you need to get lots of people to say whether I’m an okay person. You know, letters of support really. It’s quite a lot of work. 

Paula Redmond (14:03)

And what support do you think you maybe needed at the time and maybe didn’t seek or wasn’t available, what would have been helpful? 

Caroline Taylor (14:16)

Yeah, I think just more understanding of the process and understanding how the allegations mapped onto the code of conduct. That wasn’t very clearly defined. I think that maybe I should have approached the BPS to see if they could have helped me. I don’t know otherwise really. 

Paula Redmond (14:41)

Did you feel able to talk about it with other psychologists, with friends, family? How did that? 

Caroline Taylor (14:48)

Yeah, yes. I mean, some of it I couldn’t help, but just like, I’m just crying and stuff. I mean, I wouldn’t say I wasn’t supported. I was supported, but it’s just nobody else can understand what that feels like unless you’ve had that, it’s like a very unique experience, I’d say. But yeah, I think it’s really helpful for people to know where they can go to and I don’t, maybe I just didn’t look, maybe I just didn’t look and I didn’t see, but I think maybe some more support and awareness around that if there is support, that would be really helpful for the complainant and for the person that’s made the complaint. For both parties, I think for them to have, you know, HCPC, they do give a very long, you know, they give loads of guidance. It’s a very… a lot of like, wordy stuff and diagrams and things to tell you what’s going to happen. But you don’t get much, like, it’s hard to take in and you don’t, there’s no empathy in it. 

Paula Redmond (15:59)

Okay. And you spoke about the sense of relief at when it was resolved, no case to answer. But it sounds like maybe there was some kind of, it kind of hit you maybe after that a bit that you hadn’t quite realised, you said what you’d been holding. 

Caroline Taylor (16:21)

Yeah, well I was, you know, I had to prepare to, I had to prepare an alternative income. I had to prepare for that, for that possibility. I didn’t at any point think of this lightly. So I had to really think about what I would do if I wasn’t allowed to practice. 

Paula Redmond (16:51)

Yeah. And what’s your recovery been like since that? 

Caroline Taylor (16:56)

Oh, it’s taken, yeah, I mean, yes, it’s taken a long time really to kind of talk about it. It was interesting when you, yeah, it was interesting symmetry when you asked me if I would do this. I just, it’s a huge thing to lose your career that you’ve, potentially lose your career, that you’ve worked so hard to have. You know, has something been, whatever we’ve done that needs to be corrected and reflected on and thought about. I don’t really believe many people would do that out of commission. I just, my sense is that, you know, it’s messed up. Like you’ve messed up, but you didn’t do it on purpose. Like it wasn’t your intent to harm. So it’s taking a long time to let some shame go and some guilt go and think about the future in a way that I want to go forward in. Yeah, it’s taken a long time. 

Paula Redmond (17:59)

And I’m curious about whether you have any thoughts on if you were able to kind of go back to your younger self who was going through that at the time, what might you want to say or give her that could have been helpful? 

Caroline Taylor (18:17)

I would give her a hug, because that version of me would know what that feels like and it would be a different hug than anybody else could give me at that time. So it would have been a very different knowing hug. And I would, I would hope I would say to her that this is really good learning for all sorts of reasons, supporting others in this moving forward or just, just really learning because that’s, that’s what it’s for. It’s for… to make sure that you don’t just disregard what, what somebody’s concern has been, like, this is a serious thing and it needs to be treated appropriately and so I wanted to respect that as well, rather than dismiss it like I really… I remember this is to say could you reflect on what you, what you could have would have done differently and I wrote 21 things. And sometimes I see the document in my, in my files, like hidden away and I’m like I’ve said that. Gosh. 

Paula Redmond (19:33)

Well, thank you so much, Caroline, for sharing that. And I’m just going to bring Amber in at this point. And Amber, whether you have any kind of reflections on Caroline’s story there?

Amber Johnston (19:50)

Just that last piece about somehow they’re hidden, well I too have made sure that I will never encounter any email that will pop up, that has this need to move it away out of sight, out of mind, has been an important part of the closing off of this experience. So, I mean, again, we’ll get into my experience, but I can very much empathize with so much of what you talk about and how much emotion we can see that you have, you know, that’s still part of this journey of you know, the concept of it is traumatic when we think of the sense of loss, fear of, you know, our safety in terms of our integrity and our profession and our passion and the things that we love and possibly losing that, you know, is traumatic. You know, I can see that within you and, you know, I felt that and it’s a really tough thing.

Paula Redmond (20:53)

And also, guess, I was thinking, I suppose, Caroline, just that the courage to kind of remain open to thinking about it that you’ve shared in terms of how, you know, in the face of threats, it’s so easy to get very defensive and, you know, really block things. But part of the work for you has, I guess, been to try and stay open to what you can learn, to what… you know, to listen, to hear, which, you know, is hard just in itself. 

Caroline Taylor (21:29)

Which was why it was really important to have a voice outside of… So my therapist, my psychologist therapist, was quite local. So I said, oh actually, I need to take this somewhere else. And that’s why I went to another. And I didn’t, like it didn’t feel safe. I didn’t feel safe in my, in my… I just needed to reflect outside of the country. I felt that it, yeah. 

Paula Redmond (21:57)

It felt that big. 

Caroline Taylor (21:59)

I also really wanted to know what I’d done, where I’d gone awry. Like it definitely, there was no intention to harm, absolutely not, but there was harm. You know, there was. For both of us, for both people. 

Paula Redmond (22:18)

And just, yeah, just really appreciate your courage in holding that position, but also talking about it in today’s. Yeah. Thank you. So Amber, let’s, let’s kind of come to you now and maybe you could start by just saying a bit about who you are and yeah, and I guess setting the scene again, not going into the details, but how, how this complaint, you know, what the context was when, this complaint arrived.

Amber Johnston (22:50)

So my name is Amber Johnson and I am a clinical psychologist in neuropsychology and director of Healthy Mind Psychology, so a private practice. And this complaint came to my attention through an email just a couple minutes before I held my next client case. And yes, when you see this funny thing and you look at it and then you kind of try and make sense of it and then I was in an adrenaline crisis panic state for probably three hours or so, but at least that whole next session until I was able to come back and try and read that again, just figuring out what this was I came through. It really, that was a really tough moment that I remember very clearly, which is funny because I actually don’t remember a lot of details of this whole process. That’s one that I do. I remember. But the complaint was through a hospital that I was working at. From not the patient that I was seeing, but from the family of the patient I was seeing. And I was not the only one who received the complaint. There were multiple people in the facility who got a version of it. And it was about a failure to safeguard, so a serious allegation about a failure to safeguard. And the client was actually no longer at the hospital either. And so that was another part of this. All of this came kind of out of nowhere, really.

Paula Redmond (24:46)

And so how did that unfold? How did the process unfold for you? Or can you remember?

Amber Johnston (24:51)

So, some of the other context was that, you know, I was employed with the hospital for this role, but it was a part-time role while I was also beginning private practice too. So I’d only been in private practice for probably 18 months or so at the time. And I think for anybody who has made that jump, you know, it’s quite a transition and it takes a while to learn things. So for instance, all the different groups that are out there now for private practice on Facebook or different… I wasn’t in any of that. You know, I still kind of knew my hospital people being the people who I know and support. And there weren’t really other psychologists there. I had my previous place of work, which I had recently, not that recently, two years ago or so had left, and of course I had access to people there that I knew. But again, it wasn’t the same as now how much I am involved with other professionals. So it was a very lonely process. And people at the hospital didn’t really know what to do with me in a general sense. You know, the psychologists that came in and out, and there was some confusion around all of that. So I think that was part of this context.

Paula Redmond (26:19)

That you’re quite isolated professionally?

Amber Johnston (26:20)

There’s a lot of isolation professionally, yes. I mean, in a way there wasn’t because we had the others who were part of the team, but they all were in different roles. But also there was a real consideration that we needed to have a bit more silo because the complaint was coming across multiple people. You know, we had to be really careful that there wasn’t any gossiping or something unprofessional that would be happening, which is so easy to fall into. So I think those who are involved really did take that seriously, that we had to be, you know, almost like we couldn’t use our social support in the same way, potentially, because this had come across multiple people. And so I received the email and actually quite quickly after, so I guess I had a different experience, quite quickly after, I did receive what, it might have even been in the email itself, what the actual allegations were. So I could see who had made it and what the allegations were. If it wasn’t at the same time, it was quite quickly after. And so then the only thing I… now I know that I didn’t know what to do. They did instruct that you needed to let the hospital system, the director, your line manager know right away and that they would need to provide some detail. So I was able to do that. And again, my hospital, without going into detail, the complaint, the complaintee, whoever makes the complaint…

Paula Redmond (27:59)

Complainant.

Amber Johnston (28:00)

Yeah. Complainant. There was lots of difficulties. They were known to the hospital and there was lots of difficulties as probably a system with how they came in and then some of the challenges that perhaps were outside of the scope and expertise of the unit in general. And so in that sense, there was learnings across the board for everybody from, Admissions Director to CEO, to everyone around what had happened with this wider situation. And so they were very supportive of me and knew that there were others that were receiving this too. And so then I just had to go through all the notes, everything I could find, just data collecting. But I didn’t really know what else to do about this. I did end up calling the BPS and I called my insurance and neither were able to support me. And I don’t really know why, and I can’t remember which one, so I don’t want any liability here, but one of them said to me, sorry don’t you have somebody at the hospital who can support you? And to me that was awful that I was paying for services and for support and contribution for what I thought would be these kind of incidents and to be that line, another one I remember, sorry don’t you have somebody at the hospital who could support you, was so even further isolating. You know, I just felt like this was completely down to me on my own. So what happened was that once I got all this information together, it was just a, I had the complaints and the specifics and it was about a failure to safeguard and then a few other little like minor points that were connected like note taking, something around note taking. And there was a couple other things but they were like these little minor things that were involved with the big one. And so I got all my notes and I put everything together and I put some kind of response that was a little briefer of one to just, you know, respond to that. And they took information from the hospital who also had to send off all things and that was when we went into COVID. So it was at that point that then everything shut down. So everybody shut down, the hospital unit shut down. So everything had discontinued at that point. And that meant that, including my ability to really contact anybody. So then I just waited. And during this time, I was having supervision. So I had my senior supervisor and I also had my peer supervisor, a friend that’s a colleague that we have very similar, that we have very similar like, trajectories of career. So those were two different supervision kind of strands that I always use and had used during this time to really think about what I was supposed to do and how to respond to this. But during that, I waited forever. And I called a couple times and every time I called HCPC to just say, anything happening? I might get something from a case handler. And then I got something else saying, well, the last case handler quit, so you’re being passed on and then I would call and nobody would call back and then I would talk to somebody. I talked to a one case handler who was so lovely, who was just like don’t worry about this, these are things that we just need to do our job. We need to go through the process and that’s what you just need to respond as we ask and you know really just containing of you know, this is not something to panic about, we just are going through what we need to go through. So I knew I had a complaint to respond to like it met the threshold of having to answer to it. And then I heard nothing else from anybody forever. Up to a point where I started to wonder, like, has it just gone away? Like, did they lose it? Is it just not part of, I mean, is the whole world imploding anyway? So, like maybe, maybe this is apocalyptic now and nobody’s worried, I don’t know, like it just… it was really just a time when it’s just left on your own at home, isolated from everybody anyway. It was a really strange thing.

Paula Redmond (32:40)

I was just going to ask what impact that had on you? Did you have the sense of like, well, oh God, this is really scary? Or did you have a sense that it’s frustrating, but it’s going to be okay? How did that impact you?

Amber Johnston (32:59)

I think that, so I guess the situation around the complaint itself was one that was a little bit different, I think, than Caroline, the one that… My feeling around this was that I had done wonderful. In my view, we had such a great relationship with this patient. But that there was, and there’s so much compassion that I really pushed forward and there was a lot of work that we had done and there’s a lot of movement and a lot of lovely moments of rapport and connection that the people who made the complaint would never have known or seen or would not have been part of this. And the truth was that the formulation was that there was retaliation, and maybe even some evidence of secondary gain by doing this, especially across a number of groups. So this mismatch between potentially doing something for a purpose versus the impact on a person’s life that that had, when I felt I had given so much, it was those pieces. So I was clear that I had made some mistakes and one of the biggest mistakes I had made, which is a tricky one because I still wrestle with this a little bit, was that when there was a safeguarding concern revealed, I had taken steps to go through the process of safeguarding and went to my unit manager, who was also the safeguarding lead and reported the information and took, did what I was required to do and the guidance from that lead. But what I didn’t do was write in the formal, what I call public medical notes, the details of that confidential piece of information from our session. So when others receive that big chunk of notes that anybody had access to within the system or anybody who was coming into the system, including people who got a hold of the notes and then said, well that was not written in there. So therefore it was a failure of reporting and a failure of documentation, which was not quite accurate. So it became down to how to be proving these things and including going through supervision, even coming up with things like, well, maybe we should tape an envelope and seal it and put something and write it in there and then seal and then, know, tape and seal that in and these are the things that were like the learning points from it, which again, it’s still really tricky because this is a systems question, you know. But anyway, so I felt that actually the main and the more egregious parts of it I could defend but just needed other people to write the letters and to say that I had done the right things to demonstrate it. So, and then there was this piece that I had failed at, but I did for a reason, and there was a formulation I had around all the patients and the reasons for the behaviors and why this complaint was coming through. So it was just, there was a lot there. So I guess throughout that whole process, I felt like I would be able to defend something, but I didn’t know how, I didn’t know when, I didn’t know what the process would look like, if they would find holes in things, if it was sufficient. If I was potentially guilty of something, how bad would that be? Like, what would that mean? So, yeah, I guess the answer to the question is a little bit different because I had to sit with so much uncertainty for such a long time. And the truth was, I was actually really, really angry. That was what was below everything else, was the sense of absolute injustice and the fact of putting in so much to somebody and being punished in that way for a gain, you know, that it just felt so awful to me. Now, I can also say that I can also see that that is a singular way of viewing the situation and that there would, if there was a reason for gain, there are a lot of reasons for wanting to gain. You know, at the end of the day, there’s a very difficult situation that’s been life changing and everybody is trying to just do their best in this world to get their needs met. So trying to find some of that compassion as well, but yeah, I had to sit with a lot of anger. I mean, I remember times during that period of just noticing myself sitting on the couch in the dark, just ruminating for who knows how long, you know?

Paula Redmond (38:12)

Yeah. And so how did it kind of resolve and how long did that take in the end?

Amber Johnston (38:21)

So a little over a year after getting that, the something that I needed to answer to, I then got something that said you have 30 days to submit your evidence. So, which again I guess my fault maybe, I kind of just hoped you know, that it had all just disappeared, but I got straight into supervision and actually my supervisors both were willing to write statements of support for me and how much reflection we’ve gone through and how much you know, we’ve taken learning points and one of them went through a wonderful piece of advice which was like to answer this you take the HCPC code of conduct and you just go through what are the areas that have been hit and anything that you think you have or haven’t done and you just structure it out just like that. And for me, I think that was the most valuable piece of information about how to write this because I wrote something first. I wrote a defense and it was a, it was piece of creative writing for a therapist. It was not something to submit to the HCPC. But it was just this whole like, mess. And I needed to do it, it was probably a really good exercise. But you know, my supervisors, I thought that out. Now let’s take this and let’s structure this into a way that just matches up with each of the criteria, the areas where you feel that you have a defense for, what you did do, what’s outside, the areas where you could see that there was a learning point or something that, you know, you’ve been, and to have that openness and put that into writing as part of your defense. And so I then submitted that, I submitted letters from the supervisors, I submitted letters from the safeguarding lead who, you know, could confirm that I had taken all hospital procedures. And, you know, then wrote the formulation of the clients as well, including where some of the trickiness had come into and why, you know, putting these things into the public documentation has been, was a difficult bit. And I think they then had 30 days to respond to that. There was a possibility it could go to panel, which is the group or, but they responded at that point to say that I was cleared of the major considerations. The one was the note taking, but that they felt that my reflections demonstrated sufficient learning and openness to consider that I did what I needed to do following it. So it was closed at that time.

Paula Redmond (41:10)

Yeah, and what was that like to have that closure?

Amber Johnston (41:14)

Well, to be honest, the thing that was most, I mean, it was a massive relief to know, and it was a huge piece of work, like you’re saying, Caroline, a 10,000 word, or yeah, it just feels like it was this huge body of additional work to do, to go back through everything, to go through the HCPC standards, to write this big case conceptualisation and formulation. And to submit all that was a huge amount of energy and activity on top of the work I had been doing and with so much of the emotional toll too. So to have all that done was just such a huge, huge amount of relief. But they then say at the end that if you receive an additional complaint in three years following the conclusion of this, they could reopen this case, which I mean makes sense, they want to make sure that there isn’t, you know, some kind of repetition of offense or, or… So I get it, but that just meant that there was three more years of having this thing held over you potentially. And given that the original complaint came so out of the blue with somebody that I wasn’t actively seeing, it just sets up this lack of predictability that at any point, at any point, you never know. And I think that’s always going to be the thing that stays with me. Two things, my notes. My notes. Notes, notes, notes, notes, notes, all the notes, supervision notes, all the notes. And then the second is just knowing that, you know, you always have to be thinking, you always have to, you know, just be on your toes for remembering the guidelines and remembering what you’re there to do and being able to think through and justify, you know, your activity and how you do it and why. And yeah, I just think that that’s been kind of the lasting… But I actually then ended up supervising somebody else through their HCPC complaint, which was interesting to be on the other side, on the other foot, and probably something cathartic as well, because, you know, somebody is… it’s such a vulnerability, such a vulnerable place to be. And so, you know, anybody going through these complaints to recognise that it’s, it does happen and that we’re here for each other, to support each other through these terrible things. It was something was really nice to be able to help someone else, you know, to go through that and help with the shame and help with the vulnerability and remind them that you don’t go through 10 years of university to just be, you know, making all kinds of, being an error to humans. Like, there’s a lot more to what’s coming on in here and how can we work through it. And I felt like that was a really nice way to go. But at the end of that process for that person, they actually decided to discontinue private practice. It wasn’t worth it once you got through one of those.

Paula Redmond (44:30)

Yeah. Yes. And what, that question about if you could sort of go back in time and say or give something to your younger self when you’re in the midst of this, what would that, what might that be?

Amber Johnston (44:43)

I don’t think I did enough to get support because I think there was so much shame and also not knowing what to do. Now I don’t know if that would have been something I could have said to myself. I feel like I learned along the way that there are all these different ways with which we can connect with other people and other professionals. But yeah, trying to make that more clear to more psychologists, potentially even those who are well embedded in employment systems, just for letting people know that these groups are out there and they are there to be on your team. I think that was a big piece of it. I think also something about, I remember when I was going through some of the medical notes, looking over every single word and looking at what had happened and how I responded. And I would just be like, yes, I wrote that. I wrote that down. So there was these moments of going through… yeah, I got that! It was something about trusting myself, know, trusting myself that I did actually think through a lot of this at the time and just because I couldn’t remember it doesn’t mean that, you know, I hadn’t been making good decisions at the time of making them and trying to put them down into a way that made sense. So there was something in that as well, you know, me thinking back and going, my goodness, I did everything wrong and actually looking at it and going, no I didn’t, no I didn’t. I was following a lot of the procedures here and I was thinking through and I was making decisions and I just need to justify them. But that’s different than, you know, being totally out of it, an unethical practitioner, you know. But that’s what you feel. You feel like they’re saying you are an unethical practitioner, you defend yourself. And so you take that on.

Paula Redmond (46:39)

Yeah, thank you, Amber. Just turning to you, Caroline, any kind of thoughts, reflections, responses to Amber’s story? 

Caroline Taylor (46:48)

I would just say that the parallels are quite extraordinary, really. Like, it’s very similar processes and especially in relation to, you know, what, what the concerns were about, what the complaints were about were, were both about omission rather than commission, right? Like, it’s interesting that that is the case. In some ways, I’m sort of thinking, well, isn’t this great? Isn’t this great that we’ve got this structure to help us when we’re going awry, right? Like, look, it’s great, but it just needs to be quicker. And also, like, because Amber also talked about the shame. And I think, you know, to have that shame resolved a lot quicker would mean that the practitioner could bounce back quicker and then be more effective in the workplace. Like, it’s not just about the impact it has on us personally. Like it impacts on how we are. We’re cautious, like during that whole 18 months, the caution I was having, like I was being so cautious. So, you know, to a neurotic point. So I think it’s not just happening in the here and now. It’s like, what is the legacy for the complainants and the case handlers? Like, what’s happening? I find that really interesting that we’re so ashamed and we’re ashamed for a long time. But also just that it was, you know, there was neither of us had no intention to do, there was no intention of harm. 

Paula Redmond (48:43)

And thinking, I guess, just more broadly, I wonder, you know, you’ve mentioned some things like, you know, it being quicker, that, you know, the length of time it takes is clearly a big problem. And you mentioned, Amber, kind of your HCPC case handler changing and just not getting much response and, you know, I guess being in the midst of COVID as well, I’m sure it didn’t help. But are there other things that you think about the system and the process that could be different?

Amber Johnston (49:20)

I mean, I do, I think the same as you just said, Caroline, you know, this process needs to be there. It serves a very important function. You know, it’s the same as, you know, for any form of hearing and, you know, organisation that requires some way of being able to sort through and have accountability. I feel though that there just seems to be, the quality of sides doesn’t seem to be there. You have this big organisation that is terrifying but maybe a little chaotic. And then I think you have what’s often a lone practitioner not knowing clearly what to do or where to go. Even if this body could do more to be able to help somebody know what resources they should consider. Anything that just helps feel like there’s a little bit more weighing up, I think, of the big organisation that feels like it’s out to get you versus the lone person wondering, how did they end up here and what to do next.

Paula Redmond (50:32)

And it really struck me Amber, what you said about, you know, calling the BPS and calling your insurance and not getting any support. That’s really scary. And I know as, you know, as a counterpoint that the ACP do offer support to their members and, you know, they have sort of, both kind of support on a sort of emotional psychological side, but also being able to support with the more practical things and signposting to legal advice and, you know, accompanying you know, members to the panel and stuff like that, which, you know, I think is, I’m really grateful to know that that exists. Because I think you sort of assume, you know, like you did that, you know, that’s what a professional body is there for. But then to discover at the moment you need it, that that’s not true is scary as well.

Amber Johnston (51:25)

And it felt like a solicitor felt too much at the time. Like that felt like, especially when you’re going through a submit some… so my first contact and then submitting this evidence and it felt, I didn’t get it. I didn’t know what was supposed to happen. So again, my big evidence and all my real, that came after I had a case to answer. I didn’t know that it should happen beforehand because all that was really quick. So there wasn’t in my head, why would I have a solicitor involved? Like it just didn’t make sense to me. And when I call them and nobody, you know, don’t you have a hospital to go to? That means that, you know, obviously I didn’t want to make it bigger than it needed to be. So I think it was just confusion of what do you do? What are the steps? What’s the process here? And gosh, if I would have submitted my rant about this case, I wouldn’t have known.

Paula Redmond (52:25)

No. And I guess that is, I suppose, part of why, one part of why it’s so important to have conversations like this, that, you know, we are isolated and shamed into not talking about it, then it’s hard to know. Any other thoughts from you, Caroline, about what? 

Caroline Taylor (52:42)

There’s a call to arms here, that’s what I’m thinking.

Amber Johnston (52:45)

The fight response.

Caroline Taylor (52:48)

Well you know, but both of us felt unsupported. I’m sure lots of people, that means that lots of other people felt unsupported. So I think that maybe we should be talking about it more and then there’s more awareness then of how to manage what it’s like, what the sorts of things so that people can cope. Because if they’re like, I just hid for three weeks, and like was terrified. So, I just think, let’s support people, let’s support each other. That’s my line, that’s what I’m taking away. I’m like, well, we’ve got to do something. We’ve got to do something. I mean, we can’t ask the HCPC to change, but we can change as a profession in the way that we help each other. 

Paula Redmond (53:38)

And to hear, I guess, also from people like both of you that it’s survivable, that there is kind of light on the other side and I think that’s really helpful. So yeah, I really appreciate you both coming on to talk about it.

Amber Johnston (53:56)

Well thank you for having us and for pushing, I think, both of us into feeling safe to be able to talk about something that was really tough. And like you said, if more of us are sharing, and I know there’s a group set up on Facebook for those who are going through this kind of thing, and you know, I think that the more that we can kind of turn to each other to create more sense of this happens, this is normal, and we are human and we will make mistakes and that’s okay and we can own them and we can learn from them. And you know, one of the bits for me was that, you know, HCPC did say, well, you have shown that you have thought about this, you’ve sought guidance and you’ve reflected and you’ve made practice changes and that’s good enough for us. You know, that was a really important piece of this. It wasn’t just punishment. It was actually, okay, you’ve demonstrated that you are going to be a better practitioner now, so we’re happy with that. That to me was something really interesting. And I think it’s important for everybody out there. You know, we could have made mistakes and we can own up to them and show growth and they are happy that we are doing that.

Caroline Taylor (55:09)

So thank you, Paula, for bringing it to everybody, you know, like on the podcast. That’s so, because that’s the way of letting people know about how the process works and that there is help and you can go and talk to people about it. So that, yeah, that’s great. Thank you so much for packing that tricky topic.

Paula Redmond (55:36)

Thank you for listening. If you’ve enjoyed this episode, please support the podcast by sharing it with others, posting about it on social media, or leaving a rating or review. I’d love to connect with you, so do come find me on LinkedIn or at my website, and do check out ACP UK and everything it has to offer. All the links are in the show notes. Thanks again, and until next time, take good care.

The post Experiencing a fitness to practise complaint: Psychologists’ personal stories appeared first on Dr Paula Redmond, Clinical Psychologist.

Health professionals often advise patients and clients to prioritise self care but regularly find it hard to follow their own advice.  Mindfulness is one of those self care tools that can feel like another stick health professionals beat themselves with. You may know it’ll help you manage stress, but just can’t get round to fitting it in. Or perhaps you tried it but couldn’t clear your mind of thoughts so it seemed like a waste of time. 

Despite mindfulness being an evidence based tool used in the NHS to reduce mental health problems, many people, including health professionals, have misconceptions about it which prevent them from using it.

This blog will clear up some common mindfulness myths and help busy health professionals find ways to use it that suits them, even on a busy day. But first the basics.

What is mindfulness and how can it help manage stress? 

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Mindfulness increases a person’s awareness, with a sense of curiosity and acceptance, of what’s going on in the present moment. This includes stuff outside you (i.e. what you can see, hear and feel) but also inside you (i.e. your mind, body and emotions). Being more aware of these things in a curious and accepting way helps us to manage our thoughts and feelings and therefore respond to stress more helpfully. 

However, the focus on “present moment awareness” leads to the first misconception – that you are meant to be clearing your mind of all thoughts. 

It’s impossible to clear your mind of thoughts and people can have very busy minds and still practice mindfulness (like me!). But when you are mindfully aware of your thoughts you can take a step back and react differently to them. A head full of “shoulds” or self criticism becomes more manageable when we label them as “”just thoughts”. 

But it doesn’t end there. In fact when it comes to managing stress, what happens from the neck down is just as important. 

Stressful situations create physical sensations in the body that, if we are not aware of them, will build through the day and get worse. The magic of mindfulness is that you become much more aware that this is happening and can take steps to release stress from your body by relaxing your muscles or taking some deep breaths. So even though it can’t change the huge, work based demands on health professionals, it can help you change your response to those demands by helping you regulate stress in the body.

Another myth is that you have to fit in long meditations which is another big no if you’re already feel short of time. But although a regular planned meditation will certainly help you to be more mindful, weaving mindfulness practices into a busy day can also be effective. A “ mini mindful moment” really can be done anytime, anywhere by loosely following these steps: 

How to practice mindfulness anytime, any place  

• Choose an “anchor” to focus on i.e sounds, feet on floor, taste of tea. Really notice the details of that. When (not if) your mind wanders away, simply acknowledge and label the thoughts i.e. I am having lots of busy thoughts, I am noticing I am being harsh on myself.
• After a few moments bring attention to your body as a whole. Briefly scan from the head downwards, paying peculiar attention to where you usually hold tension, e.g. shoulder neck and jaw.
• Spend a few moments naming the feelings in the body e.g. I am aware I am feeling stressed, I am noticing anxiety.
• Try to release stress from the body i.e drop your shoulders, loosen your jaw, take some deeper breaths.
• Return to the chosen anchor for a few moments and then carry on with your day.

Suggestions for mini mindful moments on busy days 

Here are some suggestions for mindful moments that busy health professionals can easily weave into their day:

• When showering in the morning, notice the water against your skin, the sound of the shower or the smell and feel of soap.
• When having your morning coffee, notice how it looks and tastes as well as the warmth of the cup in your hands.
• On your commute, instead of looking at your phone or catching up with emails, set a timer for 5-10 minutes. Use that time to focus on your breath and/or body and build in a short meditation practice.
• When catching up with client notes at your desk, notice your feet on the floor and body sat on the chair. Stop what you are doing and focus on the sounds you can hear around you. Zoom into the fine detail of the buzz in the office such as chatting and photocopier etc.
• If you’re on your feet a lot, tune into the soles of your feet a few times a day. Notice the contact points they make with the floor and then expand your awareness to notice the rest of your body too.
• When having lunch, instead of eating and working, spend time looking, smelling and tasting the food. 
• On your commute home, scan your body from head to toe and let go of stress before you arrive home.

Practising little and often, in the middle of everyday activities, is a great way to start being more mindful that doesn’t take up extra time. It can be tricky to remember at first, so it can help to set reminders or commit to 1 or 2 activities you will do mindfully each day. The more you make an effort to be mindful, the more it becomes second nature.

For more information about mindfulness and how to get started visit Mind. 

Rebecca Stambridge is a mindfulness teacher and integrative psychotherapist. She spent many years working for busy national and local mental health charities as a project manager but now runs the private therapy practice “Contentedmind” where she specialises in anxiety and low self esteem. 

The post How health professionals can manage stress with mini mindful moments appeared first on Dr Paula Redmond, Clinical Psychologist.

Working as a staff health and wellbeing psychologist offers a range of opportunities to be creative. As an evolving area of intervention it invites innovation, and permission to try new things.

One of the initiatives I am most proud of is the development and delivery of an art and wellbeing collaboration called Take heART. A project that seeks to improve the experience of staff, patients and hospital visitors through creativity and the arts. But how, as a psychologist did I find myself involved in this work? Let me share a story with you.

© Shaun Armstrong

My story

For a long time I believed “I’m not creative”. This was the story I told myself….and others.  Stories that started when I was a child: attempts to learn a musical instrument, dance lessons, trying art and drama at school all seemed to feed this narrative. The crush of comparison with others reinforced a well-crafted story: “this is not for me, others do it better”. 

I pick this story up many years later when, as an adult patient I experienced the positive impact art and creativity can have on wellbeing. I was undergoing treatment that required frequent visits to hospital. With this came a lot of waiting. Waiting to get assessed, waiting for treatment, waiting for results, waiting rooms and a lot of uncertainty.

As I spent an increasing amount of time in a waiting area, I gravitated away from the main room to a smaller space. To a light filled corridor. A place where there was less waiting and more….. just being. As I made this my new regular spot, my attention was drawn to the art, a picture that sat squarely and proudly on the wall. A familiar, predictable and engaging sight. I recall an abstract depiction of a cell, inside the body. It was beautiful. On a bad day it was slightly painful to look at. It did not shy away from what those coming to the hospital were doing, the treatment they were having.

Art is open to the interpretation of its audience. What I took from it was an intriguing, distracting, honest depiction of a medical, but also emotional, process that myself and others were navigating. Art has power and presence, particularly at times of difficulty and distress. This was the start of my connection with art in hospital.

The final thread of this story can be found a few years ago. After working for much of my career in mental health services I lost my love for the work and my wellbeing started to suffer. I had an instinctive need to pause. Rather than asking myself “what should I do next?” I considered “what gives me a sense of purpose and enjoyment at work?” Supporting other staff and working in services and systems that invited creativity were up there. And so my journey working in a staff support role started. I initially worked during the pandemic with critical care and respiratory medicine staff followed by a trust-wide role. I was outside my comfort zone but inside my creative zone.  

Working in stressed and stretched care systems with limited resources and navigating unchartered territory invited new ways of thinking and working.  As both an ‘embedded’ and trust-wide staff support psychologist I was struck by the challenge of how, with limited resources my role could offer meaningful, effective and sustainable change. In a busy, unpredictable, often anxiety provoking environment, how could the hospital setting feel more welcoming, calming, engaging and soothing?

The Take HeART project

© Shaun Armstrong

Take heART has grown from connection and collaboration. It is a true team effort, a network of staff, departments and community partners coming together to try new things. As a psychologist I have been well placed to bring psychological theory and frameworks to help shape and evolve this development. To operationalise what can feel like abstract ideas such as ‘compassion’ and ‘trauma-informed care’. To support the creation of places and spaces that trigger our emotional soothing systems. Creating conditions for individuals to slow down, connect with their values and importantly with others including the local community. To enable appreciation and gratitude to be cultivated. Also, this has been an opportunity to raise and evolve the profile of my profession, to highlight how psychologists can support not just wellbeing but ‘well doing’.

How you can get started

While supporting wellbeing through the arts and creativity can be powerful, it can feel difficult to initiate and challenging to translate into behavioural change. Especially when working in high demand, low resource systems.  It can be helpful to start small and think BIG. 

‘ARTS’ is one way to guide this process and ask a number of important questions – consider Access, Resources, the Team and how to Shout about it. Try to do so with curiosity, care and a small dose of optimism. We do not need to have all the answers.

© Shaun Armstrong

Access

How can you make what you do as accessible as possible to ALL staff , especially those who do not see themselves as creative? What are the different ways individuals can participate? What invites curiosity and playfulness? What gets in the way of involvement, what are the internal and external barriers? 

For example, how could you not just invite staff to step away from their day-to-day busy environments but also bring art and creativity to them? Why not display art in team areas including staff rooms, offer a touring ‘art cart’ or join an existing staff event such as a team away day or trust staff engagement event?  

Katie Allen and Bedford Road Primary School

Resources

What resources and motivates you and others? Start with YOURSELF….what do you need? What inspires and supports you?  What are the existing budgets you can tap into? Do you have charitable funds you could apply to for initial ‘pump priming’? Are there individuals within your trust who could apply for external grants?

One starting point might be to consider what you already have. Why not create an inventory to log current artwork in your workplace? How might you showcase this?  Maybe set up an art trail? What skills, knowledge and experience would help you grow your projects? What are the strengths and skills you can bring to the work and how would you like to develop these?

Working within your limits is also important to sustain yourself and others. Developing a project plan/timeline, keeping a log of hours spent on a project and setting flexible deadlines can all help with this. As your project evolves and you seek funding, ensuring tasks such as project management and installation are budgeted for. This will create capacity and help you make a case for additional resources. Setting up a regular working group offers an opportunity to review workload, engage and inspire others and in turn create a team.

© Shaun Armstrong

Team

Who can you connect with? Who else is doing (or trying to do) this kind of work in your workplace?  Why not start with just one other person? There can be real power to partnership working. What other parts of your organisation might help?  Organisational Development, the Communications Team, Charitable Funds, Estates & Facilities, Wellbeing Leads and the Senior Leadership Team?  What about those outside your organisation?  Local artists, schools and art colleagues.  Link in with other trusts where they have more well-established arts and wellbeing programmes etc.

Feel free to reach out to take heART via our website or email.

Katie Allen and Bedford Road Primary School

Shout

Once you have started to test out some ideas, how can you shout about and showcase what you are doing and trying to do? You do not need to wait until you feel you have a well-established project. Shout early on.

When starting take heART we found it helpful to identify a name for our group and key aims and vision for the work, which could be easily disseminated.  Having a logo can help create ‘a brand’ and enable others to recognise and link different projects. Gathering feedback has been important.  Sharing what staff say about their experiences can bring the work to life. Working with our Communications Team and photographing what we do has raised the profile of our work. 

Visual artwork displayed in high footfall areas can have a powerful impact and create ‘positive gossip’. Why not walk around your work space with the Estates Team and consider where the high impact and easy to display areas are (e.g. main entrances, stairwells, lifts, corridors and waiting rooms)?  Installing large poster frames is a relatively quick, cheap and easy way to create spaces to display artwork.

Also get good at shouting about your profession and your role, showcase what psychology can bring to the table. It is not just the stories we tell ourselves, but the ones we choose to share with others that can spark change.

To find out more listen to Rachel’s in-depth discussion with Paula on the When Work Hurts Podcast.

The post Take heART: Bringing together psychology and art for NHS staff wellbeing appeared first on Dr Paula Redmond, Clinical Psychologist.

This was me in 2016. I was working in a Sexual Assault Referral Centre at the time.  A morning at work began with a staff meeting where we ran through the referrals that had come in overnight, we would hear five to six harrowing stories of assault before starting our clinical work.  So those working hours were filled with indirect exposure to sexual trauma.  What I noticed most at this time was the impact on my world-view, which became skewed towards a belief that men were dangerous and that bad things happen to people, hence becoming so wary on my evenings out.  This was vicarious trauma.

What is Vicarious Trauma?

Vicarious trauma is an occupational hazard for any helping professional who empathically engages with traumatised people.

It is the negative psychological impact of working with traumatised individuals caused by a shift in world-view [i] for example, fearing for one’s own safety or distrusting others, leading to symptoms that mirror post-traumatic stress.

Terms that are often used interchangeably with vicarious trauma include: compassion fatigue, burnout, secondary trauma and critical incident stress.

Symptoms of vicarious trauma

There are three areas in which signs of vicarious trauma can present themselves [ii] :

1. Physiological signs

• Insomnia
• Headaches
• Lower immunity (getting colds and other illnesses)
• Exhaustion
• Muscle ache and skin rashes
• Palpitations

2. Behavioural signs

• Increased use of alcohol, drugs or emotional eating
• Irritability
• Avoidance of socialising or sexual intimacy
• Avoidance of work-based activities or the opposite, over-checking emails and staying late at work.
• Decision-making difficulties
• Increased off-loading/gossiping with colleagues at work
• Avoidance of non-work-related activities
• Hypervigilance (being watchful for signs of danger e.g. checking phone or scanning rooms for escape routes)
• Avoiding TV or media stories with trauma

3. Emotional signs

• Anxiety, low mood or anger
• Feeling helpless, hopeless or guilty
• Persistent sense of dread, especially at work (e.g. going into meetings or meeting a new client)
• Feeling emotionally numb or empathically disengaged
• Dissociation i.e. mentally switching off or spacing out for short periods of time.
• Intrusive thoughts or images of the trauma you’ve heard

How does vicarious trauma affect work?

Aside from the negative impact on your emotional and physical health, if left unaddressed vicarious trauma can lead to diminished job satisfaction and efficacy at work.

Below are the three areas to look for signs at work. This is helpful for further spotting signs in yourself but also for noticing signs in co-workers or supervisees.

1. Performance: If your mood is low this may start to impact on your motivation for some tasks (or even for turning up to work on time) . It could also affect your concentration and therefore make you more forgetful. Equally, high anxiety impacts on both avoidance of tasks, or the opposite – perfectionism (e.g. re-reading emails or over-preparing).

2. Morale: It’s easy to see how the above impacts on moral. This can show up as imposter syndrome or apathy. The helplessness can lead to apathy and disinterest, feeling under-appreciated and ultimately this can impact on your connection with compassion.

3. Work relationships: It’s typical to become withdrawn at times like this, avoiding coffee breaks with colleagues for example or miscommunicating with each other (especially if others are all in the same boat). We can become less patient and struggle to delegate.

Risk factors for vicarious trauma

There are factors [iii] that can increase the likelihood of suffering from vicarious trauma.

For example, if you’ve suffered from a trauma in your personal history then you will be more likely to be adversely affected.

A higher number of clinical hours (i.e. more exposure to traumatic material) also puts you at high risk.

There is also evidence that the type of trauma you are exposed to affects the likelihood of more severe symptoms. Working with sexual violence and adult survivors of sexual abuse carries the highest risk.

Finally, if your team and work culture is not trauma-informed then you will be less protected. So, if you are applying for jobs in high-risk fields ask how the organisation safeguards staff from vicarious trauma.

The good news is that despite these risk factors there are things that you can do to look after yourself and ways that organisations can look after their staff.

How to prevent vicarious trauma

What can you do to look after yourself when working in a setting that exposes you to indirect trauma?

Firstly, familiarise yourself with the signs and symptoms of vicarious trauma.  It’s helpful to think about this as a continuum rather than in black or white (“I either have it or I don’t”) terms.  Using this continuum below think about what each part of the scale looks like for you:

Some of the things that can be really helpful for keeping yourself in the “green” zone are:

Ensuring you are tending to your basic human needs such as rest, nutrition, exercise and connection with people you care about. So often these things drop down the priority list when our emotional health is rocky or we are busy. Who or what can help you get back on track with these things if they’ve fallen by the wayside? Hobbies and mindfulness meditations would be the next thing to focus on if your basics are already in place.

It’s also important to find a ritual [iv] that will help you switch off from work at the end of the day, such as walking home and listening to an uplifting playlist; doing yoga stretches or going for a short jog.

Tap into imagery that makes you feel safe and protected when you’re in work mode, and cared-for when in non-work mode.  Spend some time developing an image and practice bringing it to mind when you aren’t stressed. This will help you to bring it to mind when you need it most. Ideas include your favourite place in nature, a nurturing person in your life and a personal achievement.

When you are edging up the amber and into the red zone consider what this looks like for you. For example, are you someone who starts to avoid tasks or the opposite; starts to overwork?  Do you tend to emotionally eat or do you lose your appetite? It can be hard to see it at the time so investing a bit of time after reading this blog to identify your personal symptoms may help you to be alert to it.

Next, take time to ask yourself what your needs are when you are in the amber and red zones.  If possible make some plans for this. If you start to edge up the continuum then you can put in more strategies to manage your symptoms. For example, reading this blog on grounding.

Think about what is within your control at work and start with managing this. For example, have you used the supervision options available to you or can you speak to your manager to set this up if it’s not already in place?  Is there a way you can decline taking on certain referrals for a while to manage your exposure to triggers?  Have you made sure you have regular holidays booked (I tend to find I need a week off every 6-8 weeks, if I leave it longer than that I really notice myself edging into the red more).

What can organisations do to protect their staff from vicarious trauma?

Whilst self-care is important it can only go part of the way to protect you from vicarious trauma.  A large review [v] of organisations showed there can be over-reliance on generic self-care such as mindfulness and relaxation. It highlighted that organisations need to go one step further and make sure that interventions are linked to the specific world-view shifts that are common for the area of trauma of each staff group e.g. in a service working with victims of violence then the intervention needs to be tailored to the worries of distrust and fear for staff’s own safety.

Organisations should consider the risk factors around higher clinical hours. For example, when I worked at the Sexual Assault Referral Centre our manager ensured that therapist positions were carved into part-time roles to avoid over-exposure to individuals.

Managers can also assess and monitor vicarious trauma amongst their staff using tools such as the Pro-Qual (freely available online), ensuring that their systems are set up to support staff accordingly. For example, offering trauma-informed supervision, having peer-support networks, providing therapy and mental health services and training staff and managers to recognise the signs of vicarious trauma.  Importantly allocating time and normalising use of these resources needs to be part of this.

Dr Claire Plumbly is a Clinical Psychologist who works with women who have experienced trauma. She has resources for women who have been sexually assaulted on her website and runs an online hybrid group/1:1 program to help women overcome low self-esteem and anxiety. Find out more at: www.DrClairePlumbly.com

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It can seem like everyone around us is making resolutions, setting goals, working out their targets, streamlining, organizing (or so our mind and social media might tell us). For some, this brings a new feeling of hope, that anything is possible, and comes with excitement, a chance to start refreshed and anew.

For others it comes with a sense of dread (“I need to try again and its hard”), disappointment (“I didn’t make it last year”), or discomfort (“This is hard”). First let us start with acknowledging ALL those thoughts and feelings.

Sometimes goal setting is not what serves us best. Sometimes, we don’t need to set ourselves targets, or make resolutions that may or may not be achievable when the world is currently so full of uncertainty. This can leave us feeling discombobulated and without sure footing.

A more helpful way can be to think about making moves every day that take us towards the kind of life we want, and towards the kind of person we want to be, rather than away. And we don’t need a January to find a point of recalibration, a compass, a choice point to navigate these “towards moves”.

The Choice Point

Instead of making resolutions I like to use an exercise called The Choice Point (introduced by Ciarrochi, Bailey and Harris, 2013). This is a brief tool that we can use to bring us back to what matters most, to re-centre, and re-calibrate our compass over and over every day. We can’t fail at this, we get to check in and re-calibrate and flex with every move.

The Choice Point lets us ask ourselves those tricky questions from a deeper, more meaningful place: should I accept this piece of work? Should I step forward for that promotion? Shall I book that annual leave? How much time do I want to spend in the office, or at home? What clients do I love to work with the most? Why am I doing this job? How do I want this telephone conversation to go, or to word that email? With every single decision we can check back in and say, does this take me towards, or away from my values, and what matters to me?

Values

How do I know what my values are? What kind of parent/sister/partner do I want to be? How do I want to show up for my community? What do I want my life to stand for? What kind of person do I want to be?  At home? At work? How much time am I spending in each of those areas? Is this the best balance for this phase of my life? You can learn more about values here.

Hooks

Sometimes when we recalibrate and check in, we get those tricky thoughts that pop up and say “Oh hang on.. what will your colleagues think of you?”, “Don’t let your colleagues down, they are counting on you”, “One more shift won’t hurt”, “Just stay one more hour and say no next time”, “Just one more patient, they need you”. These are called ‘hooks’. They are difficult thoughts and feelings that get their hooks into us and can pull as away from those towards moves.

When those tricky hooks come up pause, breathe, notice mindfully and then make an active choice. Let your mind wander back to task, engage fully and take a step back from the tricky thought in your mind. You might visualise yourself ‘unhooking’. Then experience fully the present moment using all the senses, what can you smell, see, taste, touch. What is right here in this moment for you?

Grounding techniques can be very useful for unhooking. You can read more about grounding here.

Values based action

Now consider what small step takes you towards your values in this moment? What ‘towards moves’ could you make? What are your ‘helpers’, your strengths, your tools and your resources (don’t forget your cheerleaders) that you can draw from in this moment…and this moment…and this moment.

What does this look like?

Here is an example that I have frequently discussed with clients when making decisions feels tough.  This is often because there is a values clash and it doesn’t feel like there is a choice. In this example, the hooks often feel like ‘facts’ until further mindful examination. Labelling our thoughts as ‘hooks’ allows us to step back in order to see where there may be some wiggle room, even when things look fixed and stuck.

Often our ‘towards moves’ are not big leaps, but a series of tiny movements, that open up the possibility of something that feels more aligned with our values. It is those times when we feel most stuck, that often signal a values clash, and that something isn’t working for us.

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So, this year make a choice. You might make a resolution, or set a new goal, or just take a pause and reflect. And if you don’t have the energy, or it feels too much, it’s ok. Be kind to yourself, because at any moment, at any time of year you can pause, reflect on those opportunities to make more towards moves and take those tiny steps towards that valued life.

Dr Claire Hepworth is a Chartered Clinical Psychologist and Coaching Psychologist  who loves to help make work life work well. Claire has over twenty years of experience in Psychology research and practice in the NHS and private services. Dr Hepworth offers therapy and coaching psychology to individuals who wish to enhance their wellbeing or performance. She loves to work with professionals who want to overcome self-criticism, worry and perfectionism and manage stress.  Claire works with organisations to offer consultation, coaching and training to develop evidence based psychological organisational wellbeing strategies. You can find out more about her work here: www.dowhatworks.co.uk, www.drclairehepworth.com

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So what can yoga do for me when I’m stressed at work?

Work and workplace environments are common sources of stress, so given that we now know the potential benefits of yoga, how can we incorporate it into a working day? Ultimately, the more regularly yoga is practiced, the greater the benefits on our overall wellbeing at any time. It helps to get into the habit of a regular practice where possible (even if only a few minutes per day), much like brushing our teeth on a daily basis benefits our dental hygiene. Therefore, the benefits of any practice of yoga outside of work will extend to the workplace too. Here are some ideas for incorporating practices from the eight branches of yoga at work.

Identify Yoga Time

If you are able to take some time during a lunch break, you may like to use the opportunity to practice a short yoga flow that incorporates both the psychological and physical benefits.

• Find a space you can do this (perhaps outdoors in the summer, or an empty office).
• Practice on your own, or invite colleagues to join you – perhaps it can become a new office habit together where you can additionally reap the benefits of connection through community. Before the pandemic had us working from home, some colleagues and I would enjoy gathering for just 10 minutes of gentle flow together before eating our lunch. It was a lovely way to connect to our bodies and feel we were offering nourishment to ourselves, alongside each other.
• Follow a guided practice – you can find some excellent free online resources to do this. One of the most well-known is ‘Yoga with Adriene’ on YouTube, who offers hundreds of free videos ranging from just 5 minutes up to a full hour of practice. She categorises her videos so you can find one matching what you feel you are in need of, for example: for managing stress, anxiety, anger, or boosting energy.

Breathe

Take a moment to pause. Place one hand over your heart and the other on your belly. Your eyes can be closed, or open with gaze lowered if it’s more comfortable for you. Take a long, slow breath in through the nose, filling your belly with air and feel your hand gently rising here as you do. Pause for a moment at the end of the inhale, then breathe out as slowly as you can, gradually releasing the air from your lungs. Feel the warmth of your hand directed into the heart. You could also add a mantra here, if you wish. Notice how you feel after a few rounds of this. Another great technique to promote a calming connection between mind and body is Alternate Nostril Breathing, which you can find a demonstration of here.

Mindful self-compassion

When you next grab a cup of tea or coffee, see if you can use this moment to tune into the sensations as you make yourself a drink: the smells, the colours, the sight of the steam rising, the heat from the mug… Notice this as a moment of reconnection between your mind and body, and a moment of practicing ‘santosha’, one of the Niyamas.

Shift

Before transitioning from one task or space to another (such as from a meeting to a clinical session), try spending a minute practicing a round or two of slow ‘sun salutations’. Not only is this a traditional and energising way to start your morning, it is a great sequence to reset the mind and body and shift any tricky stressed energy or emotions that feel a bit stuck. As you flow from one movement to the next in synchrony with your breath, you bring quite a literal change in perspective with each different posture. Practice with an intention to observe and move in a way that feels good for your own body; yoga shouldn’t be about how you look. Sun salutations also help to get blood and oxygen flowing through your body as you move mindfully, which has a refreshing effect. See this video for a demonstration and this article  for variations and information on safe practice.

Embody

Take a moment to tune into your body and mind; notice your current body posture, facial expression, and energy level. With this information, see if you can feel a sense of what your body and mind need right now. Then move into an asana (posture) or two that help you to embody this.

For example, if you are feeling anxious and want to nurture and embody a sense of courage, you could mindfully move into a Warrior 2 posture: spend a little time here to feel into your body, generate a felt sense of strength, stability, and warming energy as you actively engage your muscles while rooting to the ground beneath your feet. When you feel you have the posture, focus your eyes on one spot (in yoga we say “find your Drishti; point of concentration”). Stay here for as long as you wish, remembering to take long, slow breaths through the nose.

What about using yoga to manage stress when I’m at home?

Here are some ideas for incorporating some yoga practice into your home life – which will also have a knock-on effect on work stress:

• Protect some time in your day to practice – whether immediately before or after work, or last thing before going to sleep. Identify a time that seems the most doable for you.

• Let others know that this is your time for yoga and if you want to practice on your own, ask not to be disturbed. Or invite your partner, child, or housemate to join you! While yoga can be a personal practice (and can broaden your sense of connection to all living things), it is also a great way of connecting with others and feeling a sense of community.

• Find what works best for you and your wellbeing, which may be a mixture of both individual and shared practice. You could use the free resources mentioned here, or find yourself a class to attend online or in person. There are many options available now, so you can also ‘shop around’ and see which suits you best.

• If you are looking for deep rest and relaxation, or stress affects your sleep, you may gain particular benefit from yoga nidra, which is a highly accessible guided meditation practice done lying down. You can find free audio recordings online here.

As a clinical psychologist, I have been excited to explore the practice of yoga and the ways in which it can support psychological wellbeing, including as a supplement to talking therapy. With its wide variety of practices, I believe yoga can be accessible to all, but of course there are other mind-body practices that you may feel more connection with, such as Tai Chi, or Qigong. There are many different traditional and modern methods for practicing all branches of yoga and therefore it can be quite confusing to know where to start. You may wish to explore some of the different approaches (such as Vinyasa, Hatha, Yin, or Restorative) and see which you find most accessible and that you most connect with and find benefit from. As popular YouTube yoga teacher Adrienne would say, “find what feels good” – it’s about what works for you in service of your values.

Please note – if you’re planning to practice yoga for the first time, please take a moment to assess if your body is ready for some of the physical practices. In particular, if you have any health conditions or concerns, recent illness, or have doubts about your fitness and health, then check with your doctor first for any advice before starting a new form of physical exercise. You may also wish to practice under the guidance of a qualified yoga teacher, either in a private session or group class.

Dr Bethany Stroyde is a Clinical Psychologist and Yoga Teacher with a special interest in mind-body approaches and works with adults. You can contact her at BethStroyde@Protonmail.com, follow her on Instagram at @heartmindbodypsychology, and find her website at heartmindbodypsychology.com.

The post 5 practical ways to incorporate yoga into your working life appeared first on Dr Paula Redmond, Clinical Psychologist.

When people think of yoga it might conjure up images of glamorous young women twisting into challenging shapes in exotic locations – thank you social media. It’s also not uncommon to hear people say, “I’m not flexible enough to do yoga”, which seems to reflect and reinforce an unfortunate misconception about what yoga actually is and who can practice it.

Naive for years myself about yoga (I had assumed it was simply an exercise regime similar to Pilates!), it was a day of training during my Clinical Psychology doctorate that opened my eyes to the full scope and potential power of yoga to transform our lives for the better. I learned that anyone can practice yoga and feel the benefits.

How and why can yoga help with stress?

Maybe you have some familiarity with yoga already, either from hearing about it, or from having attended classes. However, you may be less familiar with the history, science and full scope of the practice of yoga and its relevance to our wellbeing…

Is yoga not just striking a pose?

Yoga is an ancient systematic practice rooted in Indian philosophy. It is not only the physical practice that we see images of everywhere – that is only one of eight branches of the practice of yoga. Together, the eight branches cover physical, psychological or psycho-spiritual, and ethical practices. They are called:

• Yamas: interpersonal ethics (how we treat others)
• Niyamas: intrapersonal guidance (how we treat ourselves)
• Asana: physical postures and movements
• Pranayama: breathwork
• Pratyahara: controlled senses (aligns with mindfulness approaches)
• Dharana: concentration
• Dhyana: meditation
• Samadhi: enlightenment (links to connectedness and values)

They are listed in this order intentionally, as the first four practices are concerned with how we live in the external world and act as preparation of your mind and body for practicing the following four, that are more concerned with our internal world. While they all connect and build upon each other, we can decide for ourselves which parts work for us in terms of our values and how we want to live our lives.

When I began to learn more about the eight branches, I discovered that there is much crossover and alignment with some Western models of psychological therapy, particularly compassion-focused therapy and acceptance and commitment therapy.  This furthered my interest in how the practices and benefits of yoga could work alongside clinical psychology.

What are the benefits of yoga?

The benefits of yoga have been recognised for thousands of years, but we are now able to examine more closely and objectively the mechanisms of this thanks to modern scientific methods and technology. Yoga practices essentially improve the connection between mind and body, through both a ‘top-down’ neurocognitive pathway and a ‘bottom-up’ neurophysiological pathway. By engaging the mind and body simultaneously and bi-directionally we can improve both our ability to self-regulate and our resilience (returning to homeostasis after stress).

From ‘fight or flight’ to ‘rest and digest’

The role of the autonomic nervous system is key here, with its sympathetic branch (commonly known as ‘fight or flight’) and parasympathetic branch (often referred to as ‘rest and digest’). When the body is in a state of stress, the sympathetic branch is activated. Again, this is not always an unhelpful thing because we need the body to be physically prepared for certain situations through increasing our heart and breathing rate, etc.

However, sometimes we find ourselves in this ‘fight or flight’ mode when it’s not helpful.  Furthermore,  regular activation of the stress response and difficulty returning to a state of ‘rest and digest’ may leave you feeling chronically stressed and can impact on your health.

Through yoga practices we are able to have direct influence on regulating the autonomic nervous system, so that we spend less unnecessary time in ‘fight or flight’ and move more easily and flexibly into ‘rest and digest’, where we feel calm, relaxed, and more able to connect with others.

The evidence for breathwork

Breathwork (pranayama) has the most scientific evidence to date, with numerous studies now demonstrating how changing the way we breathe has significant positive impact on our physical and psychological wellbeing. For example, many breathing practices involve extending the exhale, which stimulates the parasympathetic system and therefore calms our entire system.

Breathwork has also been shown to improve heart rate variability (HRV), which indicates the relative balance between the sympathetic and parasympathetic systems. When these systems are well balanced (good HRV), we are more able to calmly assess and respond to everyday situations, meaning we have more choice and control over our behaviour. Poor HRV makes people more vulnerable to a variety of both physical ailments and mental health problems.

By practicing pranayama we can improve our HRV and help to reduce secretion of the stress hormone cortisol, alongside increasing protective anti-inflammatory markers.

Strengthening mind-body connections

Research has shown that we are more prone to stress when we are out of touch with our body and the signals it sends and therefore less able to meet our needs before those signals become alarm bells. Essentially, the better the connection between our mind and body, the better our ability to cope with stress.

When practicing asanas, we move our bodies in synchronisation with the breath and focus on the sensations arising moment-by-moment. Through this we begin to notice connections between our emotions and our body, enabling us to begin to explore what happens if we move or breathe a little differently, enhancing our interoceptive awareness.

Strengthening this connection between mind and body helps us to better interpret our physical sensations.  This is vital to being able to navigate safely through life (for example, being able to read danger or hunger signals). As Bessel van der Kolk says in his bestselling book, ‘The Body Keeps the Score’: “If you are not aware of what your body needs you can’t take care of it”.

Once we become more viscerally attuned to our needs, we may find ourselves developing a new authentic and naturally arising capacity for self-care.

Other stress-related benefits of yoga

Further benefits related to stress include (but are not limited to):

• Improvements in digestive health including from irritable bowel syndrome, which is often linked to stress or anxiety
• Improving cognitive flexibility by facilitating neuroplasticity through increases in brain-derived neurotrophic factor (BDNF)
• Increased capacity to manage pain, including chronic pain
• Activation of mirror neurons when moving with a group or following a teacher, which increases empathy, compassion and a sense of connection – thereby stimulating our ‘soothing system’ – an antidote to stress.

How to incorporate yoga into your work life

As we have seen yoga can have enormous benefits for managing stress at work and at home.  In the next article I outline practical ways to introduce yoga into your everyday working life.

Dr Bethany Stroyde is a Clinical Psychologist and Yoga Teacher with a special interest in mind-body approaches and works with adults. You can contact her at BethStroyde@Protonmail.com, follow her on Instagram at @heartmindbodypsychology, and find her website at heartmindbodypsychology.com.

The post Can yoga help me to manage work-related stress? appeared first on Dr Paula Redmond, Clinical Psychologist.

The impact of procrastination

The problem of procrastination is well known and long standing- as are its effects. At a personal level there is extensive research on its emotional impact, creating stress, anxiety and guilt. This is a fact that gives lie to the often-expressed suggestion that procrastination is a healthy response to pressure. Over time it has the corrosive effect of further breeding indecisiveness, uncertainty and lack of confidence.

Marc was a university lecturer who had a reputation amongst both his colleagues and students with always being late for things – whether it be marking papers or attending meetings. He constantly complained about being overworked and stressed out although he was known to be one of the most active users of Facebook.

Large scale studies have focused on its effects amongst students, managers and professionals – typically anyone who largely has control over their own time – and findings point to poor academic achievement, salary loss and loss of quality time with friends and family as just a few of its negative effects.

Jan, a senior NHS manager, had a reputation for being hard working and decisive. In practice however she worked 14-hour days, spent a large amount of time “chatting”, agonised over decisions and was the focus of complaint from her family who “never saw her”.

Regarding physical health, its not surprising to discover that procrastination over addressing health concerns typically leads to worse outcomes. And anyone who has thought about losing weight or starting to exercise, knows that procrastination is a major problem.

Carl decided to be upfront with his GP. “I’m here because my wife pressurised me. I know I often have a bit of blood in my wee but it’s not like it’s a regular thing” he said. “How long’s it been going on for?” his doctor asked. “About a year or so” Carl replied.

As a Consultant Clinical Psychologist I first became interested in procrastination over a decade ago. I would rarely see clients who presented with procrastination problems but many of the problems they typically had involved procrastination – whether as a causal factor or as an effect.

Sometimes they would just see it as a fact of life: “I’ve always been a procrastinator. Everyone in my family is”.  Others would describe putting off decisions for fear of making the wrong one, or simply putting something on the back burner because it was boring.

The trouble with time management techniques

There isn’t any shortage of books on what causes procrastination but understanding procrastination isn’t the same as knowing what to do to change it. And here the literature is thinner on the ground. What does exist primarily focuses on Time Management techniques- the 80/20 Principle, list making, the Pomodoro technique and so forth.

What I discovered, however, was that my clients just never seemed to be able to put any of these techniques into practice. It quickly became clear these books had key factors that were missing. Factors that related to the lack of a good scientific understanding of motivation, feelings, beliefs and behaviour change.

The more I worked with my clients on the problem the clearer it became to me that procrastination was primarily about Uncomfortable Feelings Intolerance (UFI).

Procrastination is like an addiction

Let me explain. Procrastination arises when you are confronted by a task that makes you feel uncomfortable – bored, mildly anxious or annoyed. When you look at what you do when you procrastinate – look in the fridge, surf the web, do another task or play a game on your phone – none of these things are particularly fun or joyous. However, what they all IMMEDIATELY do is take away the feeling of boredom, mild anxiety etc.

The effect of this doesn’t last very long and so we have to repeat the behaviour again after a while. But it is so effective it becomes addictive. Indeed it became clear to me that chronic procrastination is akin to an addictive behaviour. This is why time management techniques don’t work. They don’t address motivation or feelings.

The more someone procrastinates, the more they come to depend on procrastination to manage their feelings of boredom etc. And the more dependent they become the more powerful and uncontrollable those feelings seem to become. Procrastination starts to feel like like the only, and most irresistible, option.

The MUSCLE technique for overcoming procrastination

Luckily Integrated CBT has a range of options to offer in successfully tackling procrastination. Over the last decade working with hundreds of clients I developed a specific programme -IWantToStopProcrastinatingNow – based around the MUSCLE Technique which enables clients to overcome their problem – and most importantly to maintain that change over time.

MUSCLE stands for Motivation, UFI (Uncomfortable Feelings Intolerance, Spot (unhelpful thoughts), Change (thoughts through cognitive doubt and defusion), Learn (the IF/THEN technique) and Engage (fully in your life). It operates as a set programme designed around 10-20 specialist exercises depending on time and need. It recognises that change will often be uncomfortable but never painful or impossible and that confidence and improvement will become observably visible as you implement the programme.

The MUSCLE programme uses the metaphor of a gym and the move from being flabby to being toned. It doesn’t happen overnight. It should be done slowly and methodically but it gets easier over time. You also start off with a slow-moving horizontal treadmill once a week not daily heavy weights! Let’s unpack this in more detail.

Motivation is about discovering why you want to stop procrastinating now. If procrastination is addictive and chronic, you have to be clear about why you want to change things.  This is usually about either wanting certain benefits or (much more commonly), wanting to get away from negative consequences of your procrastination. Starting from this point will help give you the drive to do the hard work of tackling your procrastination.

Uncomfortable Feelings Intolerance is concerned with developing a “thicker skin” so that minor uncomfortable feelings like boredom don’t end up becoming all-powerful monsters in your imagination that you feel unable to resist. This is about noticing that there are already lots of tasks you do automatically which are boring and mildly anxiety provoking that you do not procrastinate about.  Becoming mindful of this can empower you to be more tolerant of this discomfort.

Spotting unhelpful thoughts is key to stopping procrastination.  Start to notice how your mind works when this discomfort shows up. Can you spot any patterns? Some common ones are Permission Giving (“I’ve had a tough day; I’ll leave all my admin for now”) and Catastrophising Thoughts (“Even thinking about doing this does my head in. I can’t handle it”).

Changing thoughts is achieved by reducing the impact of unhelpful thoughts on mood and behaviour – via two main routes. The first (from 2nd wave CBT) to the change the CONTENT of beliefs. For example from “I can’t handle this” to “This isn’t straight forward but I can get to grips with it”. The second (from 3rd wave CBT and most specifically from ACT) is to change the relationship you have with the thought (whatever its content). “I can’t handle this” becomes less of a compelling truth and more of a passing thought.

Learning the IF/THEN technique (or Implementation Intentions) is a well established evidenced based strategy from social psychology that can DOUBLE the chances of behavioural change. It involves identifying triggers for desired behaviour relating to both the task you want to achieve (e.g. getting an essay finished) as well as how to avoid obstacles (e.g. what to do when a friend pops in and asks whether you want to go for a coffee instead).  An IF/THEN plan looks like this:

If (or when) [___situation__], then I will do [___behaviour__]

Engage fully in your life involves ensuring that you successfully embed your learning into your life. We’ve all read interesting books or attended great courses, but a month afterwards they become faded memories. We need to develop routines and rituals to support practice and repetition so that new ways of responding become as habitual as our old ways.

Next Steps

Procrastination is a problem you can deal with as long as you recognise that it’s something you do to manage feelings – and pretty minor feelings at that. Time management strategies aren’t the answer-nor are quick panaceas. Typically it’s a habit. But there are range of powerful evidence-based strategies available to you which will ensure you succeed. Just don’t procrastinate in starting!

If you want to learn more about the MUSCLE technique and how to put it into practice check out the I Want To Stop Procrastinating Now programme.

Paul Grantham – Consultant Clinical Psychologist, Professor of Clinical Psychology PSMedUniv, Accredited CBT Therapist. Author of I Want To Stop Procrastinating Now and Director of SDS Seminars Ltd. Paul can also be contacted via paul@sds-seminars.com

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