Reaching the summit?

For a long time, I’ve had a metaphor in my mind about how it feels to run a small business aiming to change children’s social care. The image is of me rolling a massive boulder up a hill. Progress is slow, it is hard work and I often find it tiring. Even when I rest I have to do so holding the rock in place. At times I feel like I might be reaching the summit, only to see that there is another climb ahead. I sometimes wonder why I’ve taken on this mammoth task, or whether my goals are even possible, but I am stubbornly determined that now I’m so far up the hill I don’t want to give it up. Maybe that is about sunk cost. But I’ve chipped off the worst of the bumps from the rock and got my rolling technique worked out, so I keep telling myself that if anyone can get this thing to the top of the hill, I can. Over the years of my journey I’ve tried to encourage other people to help me to push, so I am not bearing all the weight, but whilst I’ve had good company at times and plenty of encouragement, it has always seemed like the task is mine alone. That has been reinforced by numerous people telling me how I’m uniquely skilled at rock-rolling, even though I know that I was no better than many other people at the start of my journey. In fact I’m pretty sure anyone with some pretty basic skills who rolled a rock for this long could be standing in my shoes.

Of course, that bypasses the fact that I had to be willing to spend a lot of time on this, be resilient in the face of obstacles, and give up other easier opportunities to stick with it. And the fact I had the intellectual, social and personal characteristics to work out how to do this, choose a viable route and make improvements along the way. And it also omits to mention that had I known the real scope of the task would take me over a decade I might not have taken it on at the beginning. On the other hand, perhaps the fact it was difficult enough for nobody else to take on was why I did it. I think those who know me might point out it isn’t the first time I’ve jumped in at the deep end, and that I don’t do things in half measures. I don’t like taking the easy route in life, and if I set myself a challenge I like doing the task properly. I’ve always thought about what I can do to make the most impact, rather than to have the easiest life or earn the most money. I prefer to cut my own path, than to take one that is already well-trodden, and to find a way to enjoy the challenges of the journey.

So here I am, pushing my boulder and feeling like I’ve come quite a long way over the years. I might be deluding myself, but the gradient appears less steep these days. In fact, it feels tantalisingly close to reaching level ground, and I am starting to imagine what it might be like to roll my boulder down the other side of the hill. I’m trying not to be complacent that I’ve reached a point at which the boulder is stable enough not to roll back the way we came up, but people are starting to talk about how this boulder is not just on the level, but given one more push might gain enough momentum to create a landslide that will divert the river to irrigate the lands the local population need to farm. That would be beyond my wildest dreams. I mean, the motivation behind all this is to improve the lives of people who are having a tough time, but to think that it could have impact on the scale some people are now anticipating is mind-blowing. That would mean my big gamble of investing so much time and effort into this project could pay off in terms of impact. In a way that’s the great thing about indirect interventions – that they can make change that ripples out on a much bigger scale. In my boulder metaphor I’m trying to make change not by trying to teach them new farming skills one by one, but by trying to address some of the systemic barriers that impair their life chances, so that they have the opportunity to find their own ways to thrive.

So this blog is a marker of me standing at what I hope might be the top of the hill, and crossing my fingers the gaining momentum part happens. The mixture of hope and uncertainty is stressful to balance. When it’s a bit more concrete I’ll write a bit more, and hopefully I’ll not need a metaphor to couch my cautious optimism in, and can tell you about the actual project and the steps I’ve taken to progress it.

Pushing upwards

When I was an undergraduate psychology student, I found parts of the course curriculum kind of boring. I was interested in human behaviour and experiences, because I wanted to understand how to alleviate distress and increase wellbeing. Unfortunately I was not so interested in the neurochemistry or neuroanatomy that is the underlying mechanics for those emotions and behaviours. I was interested in behavioural ecology, like the evolutionary/survival value of altruism to vampire bats, and its parallels in human behaviour (eg why we have developed a system of rules and punishments to enforce the social contract). But I wasn’t so interested in animal perception and cognition. I found some of the early psychological experiments on both animals and humans to be really cruel and distressing, though I was aware that they helped to progress our understanding of brain and behaviour, and helped us to recognise the need for the ethical considerations we apply to experiments now.

Because I didn’t love the whole course, during the second year of the course I began to wonder whether I had selected the subject on autopilot, because my Mum is also a clinical psychologist (now retired).  A few other life events compounded this lost feeling by lowering my mood generally* and I developed an increasing existential doubt about whether I was making the right choices in my life.  I also wanted to test out my values and the options available to me, so my focus drifted to my social relationships and activities outside of psychology. I became less motivated and didn’t attend all of my lectures, and (despite having previously been quite successful in educational assessments) I got a 2:2 for one module that I hadn’t enjoyed. It was a mark that fairly reflected my effort/interest level, and in any other context it wouldn’t have been a big deal. However, I was gutted because I felt like the whole course would be pointless if I didn’t excel academically, as I was aware of how competitive the path into clinical psychology was. I considered changing course or dropping out, but I couldn’t think of anything I would rather do.

One of the images that helped pull me through that time, was from the I Ching – an ancient Chinese book of wisdom, also known as the book of changes. The basic gist is that you throw coins to point you to one of 64 readings, which can be generated with various variations and additional comments, and (like a horoscope or cold reading or fortune cookie, but perhaps with a bit more zen wisdom) the resulting text is ambiguous and non-specific enough for you to draw relevance to your life situation. The page that I was sent to was called “pushing upwards” and the hexagram was of wood below the earth. The image it described was of a seed below the surface, using all of its stores of energy to push a shoot upwards in the hope that it would reach the light and conditions in which it could grow and thrive. The text explained that to do this is an effortful process, in which you are gambling that this investment of energy will be worthwhile in reaching a goal that might still be out of sight. It describes the heaping up of small efforts to create the conditions in which future success is possible. The seed takes time to unfold into the tree: Although the results are not immediately visible and gratifying, “that which pushes upwards does not come back”. The reading tells you to put in a sustained effort if you want to achieve great things. It reassures you that if you are driven by a deeper sense of purpose (rather than wealth or glory) and willing to learn from wise people around you, you should not fear the path ahead. It implies that in time favourable conditions will help you along. In this way, it says, a person can rise from obscurity and lowliness to power and influence, provided that you make your efforts in a humble, flexible and authentic way.

This was a good metaphor for needing to put in more effort to achieve my goals, and it also reminded me of my core values and my drive to in some way make the world a better place, by improving the experience of other humans who had been dealt a tougher hand in life. Thankfully, as I entered my third year I got together with my husband (who has continued to be a supportive and stabilising influence for more than two decades since) and entered a much happier phase in my life. I also found the modules in the final year of undergraduate much more relevant to my interests, because they were much more closely tied in to the theory and practice of clinical psychology. As a result I started to put in more effort and get higher marks. I also started to gather work experience, and to seek out advice from qualified CPs. Gradually, those efforts paid dividends – I secured an AP post on a research project straight after graduating** and then worked incredibly hard to do that job, write up papers for publication and complete a masters degree by research at the same time, before gaining wider experience in a more clinical role with a different client group and then securing my place on clinical training.

From the moment I entered that third year with that mindset, I enjoyed the rest of my journey into clinical psychology. No matter what the client group or type of work, I felt like I was doing something worthwhile and I was also constantly learning and being challenged. I had some inspiring supervisors, both as an AP and as a trainee. I didn’t love every placement (they were all good learning experiences, but my enjoyment varied depending on my interest in the client group, the style and context of the work, and the amount of travel involved to get there). Likewise I didn’t click with every supervisor equally, but I did learn a lot from each of them. In my first AP role my supervisor was a role model of the true scientist practitioner, who secured grant funding to push forward the evidence base of the clinical work, and constantly published papers and disseminated findings. She pushed me to participate in that world, and with her support I co-wrote six peer reviewed journal articles during those two years! She is still my role model of embodying the link between research and practice in psychology, and I would love to emulate Esme’s energy and influence in my own field of work. I then worked in a project that trained student social workers, and assisted with expert reports on parenting – something I continue to have an interest in to this day. It gave me a much more practical grounding, and an awareness of social care systems that I have subsequently built on.

As a trainee I gained a basic grounding in brief CBT-based interventions in an adult service, and learnt more about the structure of mental health services and working as part of a multidisciplinary team. I also worked in services for people with intellectual disability, where I learnt about the value of indirect work, and gave more explicit consideration to issues of capacity and consent. I loved my core child and family placement, and the warmth, pragmatism and commitment of my supervisor, Patricia, set the tone for the kind of psychologist I wanted to become. I returned to her for a specialist placement to pick up the cases that were more complex, transgenerational or involved child protection issues that I had avoided the first time around. I was lucky enough during that second specialist placement to also have the opportunity to work one session a week into an NCH Action for Children project for child and young adult survivors of sexual abuse. There I was reminded of the value of human connections over any academic knowledge, as well as having the opportunity to use Cognitive Analytic Therapy for the first time. I also did a specialist placement in a child development service, with some work into a sexual abuse team – including working with children who had survived abuse and co-facilitating a group for mothers whose partners had sexually abused their children. I learnt more about complexity and systems, and some healthy cynicism about organisational change. I still remember the chart for the new tiered model of services pinned up on my supervisor’s wall, with ovals that widened at lower tiers, entitled “the shape of future services” to which he had added a handwritten subtitle “is pear-shaped”.

When I qualified I was torn between a post with the favourite supervisor I had spent two placements with and one that several people warned me was “burnout waiting to happen” working in child protection. After a long discussion with a good friend I concluded I wanted to continue to challenge myself, and also to put myself where I was most needed. I therefore took the latter post, and worked in a split post across CAMHS and child protection. I learnt from a fantastic supervisor how to work in complex systems and services. David also taught me how to be an expert witness for the family court. The balance between being down-to-earth, approachable and yet grounded in knowledge and theory, as well as the clear communication under pressure gave me another role model of the type of psychologist I wanted to become. He taught me to ask the uncomfortable questions, and to balance holding empathy for parents with speaking up for the best interests of the child. Then in my longest standing post, I learnt from another fantastic head of service to think about process in supervision, how to bring fun and creativity into my work, and also to pick my battles! I also did a lot more collaborative work, and got involved in service development and audit, as well as gradually stepping up to greater supervisory and management responsibility. In that post I had the benefit of working with an inspiring social work team manager who had been doing really innovative work to increase access to permanent placements for older and more complex children. I also went out to America for a couple of weeks to train with Dan Hughes, where I learnt about the power of being present in the intersubjective space, and became more willing to show my own vulnerability and emotional reactions.

I have also learnt from less positive experiences – the times where I got it completely wrong, or unintentionally triggered negative responses in others. For example, I remember an AP I supervised feeding back disliking that I had introduced her to colleagues as “my AP”, intending that to be as supportive as I had perceived it being when I had been an AP myself, rather than as indicative of any claim of ownership. I remember crying when criticised in a multi-agency meeting about the autism pathway, and realising too late that it had been a bad decision to come into work that day whilst my house was flooded and I didn’t have enough emotional resources for work. I still cringe looking back on one time I tried to be supportive to a junior colleague who had to give evidence in court, but ended up making myself look stupid and inhibiting her ability to impart her observations in a useful way. I recall the challenges of having to raise concerns about how a colleague’s homophobia might have a negative impact on service users, and how they justified this being part of their cultural and religious identity. I remember the camaraderie, but also the pressure of working within a big system, feeling responsible for protecting more junior colleagues from organisational changes, worrying about waiting lists, and defensively managing referrals.

Most of all, when I think about negative experiences, I remember how gutted I was when my wonderful employing organisation lost the competitive tender for our service, and how horrible the initial meeting with the new service directors and managers at our new employing trust was. It started with a gloating talk from the new clinical director, and him taking digs at our senior staff about how some people in the room might think they know how to run CAMH services, but clearly he new better as they had won the tender. The jokes about how nobody need worry about their job security, except the consultant grade psychologists, as “you are quite expensive and we haven’t figured out what to do with you yet”. And the patronising response of the service director to my questions about whether the plan for my service section in their tender specification was fixed: “If you think you can do better, cheaper, love, knock yourself out”. I remember the pressure to rewrite the service specification and job plans for my team whilst my kids were in neonatal intensive care, and to take on various tasks to compensate for the fact they hadn’t appointed a locum to cover my absence. I remember my team being left out of the accommodation plan entirely whilst I was on maternity leave, and after protesting, returning to an undecorated, unfurnished office without internet or telephone points (or mobile reception) that could only be accessed by swiping out the fire exit across two flights of stairs, then swiping into another wing of the building and going down to the furthest end of the corridor. I remember being told to income generate or face temporary staff on my team being made redundant, and then being told that I was allowed to neither quote nor invoice as I wasn’t a budget holder. I remember being promised time off in lieu for all that I did during my maternity leave, but then being denied this on my return as “we can’t pay you full-time pay for part time work, no matter what you did in the previous financial year”.

I remember the day I walked out of a meeting with an operational manager, out of the building, out of the car park and down the road, and felt like I could keep walking forever and never go back. In the end I walked across town to my previous base and talked to the directorate manager there, who made it feel less personal. Over the following weeks I sought out some personal therapy through Occupational Health, and picked apart what was me and what was the toxic system around me. Then I decided to take a career break and spoke to HR to confirm that I would be able to continue my self-employed activities during a career break without this being considered “taking up alternative employment” and blocking my right to return. I also wanted confirmation that I would return on the same grade to the same client group. I always joke that the HR lady I spoke to should never play poker, because as I told her my reasons for leaving her face gave away too much. I watched her non-verbally say something along the lines of “oh shit, we’re in trouble here, pretend we’re not, pretend we’re not” before casually raising the option of redundancy and a gagging contract***.

So I had to uproot and push upwards into new an unfamiliar soil. Initially I applied for other NHS jobs, but ended up withdrawing before interview for one and declining a job offer for another, because I wasn’t prepared to work in another toxic culture. In the end I used my expert witness work as my parachute, and figured I would work it out as I went along. I changed from being a sole trader to a limited company so that I could employ an AP. I felt like I had been gradually dehydrated by the conditions I had worked in until I was just a husk of myself, and as I started doing my own thing I found some rain I started to find my own shape again. At first I used my own business to try to achieve what I had hoped to in my NHS career independently. As I have said in previous blogs, I helped set up a parenting charity, but felt the political agenda of the founder wasn’t consistent with the clinical goals. I secured funding for, designed, managed and evaluated a service to support people with diabetes, but ultimately it wasn’t commissioned. I set up a psychology service within a social care provider, and trained staff all across the country, but whilst I enjoyed the work I didn’t enjoy spending so much time away from my home and kids.

The challenges have continued, as I have had to foster my entrepreneurial side and learn the skills to run a business, hold a budget and manage staff. I’ve found new ways to disseminate knowledge – through being on committees, doing policy work, and writing for different audiences in my book, practice journals and on social media and this blog. I’ve developed ways to use technology to improve services, and I’ve returned to doing research. I’ve had to be flexible enough to try new things until I’ve been able to find a way to work that feels authentic. This blog documents much of that journey.

Through it all I have never been bored or complacent about my work. I’ve always enjoyed finding new challenges, and new ways to apply psychological knowledge. I have always found that my work provides moments of flow – that sense of deep and satisfying immersion in the present moment to the exclusion of everything else, that you get when you have sufficient agency and skills to meet a challenge, and feel a sense of reward from doing something well or contributing to something worthwhile. By comparison with so many people who do repetitive, boring or physically challenging work, I feel a great deal of gratitude that I earn my living doing something that is so varied, with so much autonomy and opportunity for enjoyment. Thankfully I have always been able to find sufficient challenge and novelty in how I work, along with sufficient freedom to satisfy me. And there have always been new human puzzles that intrigue me, and the varied settings and ways of working that I have experienced each involve looking at what I have to offer afresh and customising what I do for the new context.

 

So here I am, running my small business and trying to establish the use of structured needs assessments and outcome measurements in children’s social care. Once again, those themes of pushing upwards are back, as I have been putting in a big investment of time and effort to nurture this project over many years in the hope that it grows into something productive. Now that I am more established and have a mortgage to pay, plus rent on my office and employee salaries it feels like a bigger gamble than early on in my career where I had little to lose. But I have that same feeling of clarity about where I want to make my impact in the world that I did when I decided clinical psychology was for me after wavering as an undergraduate. I also have the same faith that my cumulative efforts will eventually be repaid with positive outcomes and a move into easier progress. If I go back to the image of the seed growing underground, I’d like to think that the journey through the earth has been completed and the new shoots are now reaching up into the sunlight where they can be replenished by energy from the external elements. I know as a gardener that with good planning and regular nurture the slow growth of seeds sown over winter can quickly turn into the rapid growth of spring and summer. I can only hope that I’ve done enough to establish my new plants and all this effort comes to fruition soon!

*My landlady decided to sell the house I was renting (despite having agreed I could stay on there in my third year), so I had to find an alternative place to live. My Dad was tested for prostate cancer. And I experienced the second incident in this past blog about rape culture in which I felt at risk of rape.
** Before you say “it must have been easier back then” I would note that I got that post against 110 other applicants. So even in 1995 things were pretty competitive, and probably more effortful as we had to find job adverts in the BPS appointments memorandum booklet that was posted out with the Psychologist magazine, phone up for an application pack, and then post in a hand written application, as NHS jobs didn’t exist and internet based application systems had not been invented yet. Which makes me feel very old.
*** A legal “compromise agreement” that included terms saying I would not tell people why I was leaving or speak negatively about the trust from which I departed, and could not take legal action against them – terms I understand are pretty common in that situation, but the government has subsequently outlawed after bad publicity, as they can be seen as an attempt to silence whistle-blowers.

Seeking collaborator to change the world

LifePsychol Ltd is a company with a clear social purpose – to improve outcomes for people who have experienced adversity through the application of clinical psychology, particularly children who are Looked After in public care after trauma or maltreatment. We deliver effective psychological services for Looked After and adopted children by providing assessments, formulations, therapeutic interventions, consultation, training and outcome measurement tools for placement providers. And we are very much in demand. But at the moment we are clinician led, and we really need a COO with complementary business skills as the company scales up, to ensure that we make the maximum impact going forward.

We are at a very exciting time, with the potential of rapid growth and the first evidence of efficacy for our pathway emerging. We have started the process of applying for DfE Innovation Programme funding, and we have great support from key people (Sir Martin Narey, government advisor who just reviewed the future of children’s homes in the UK, described our pathway and tools as “the missing link for the sector”, Jonathan Stanley at the Independent Children’s Homes Association described them as “the new gold standard for our members”, whilst Lord Listowell said the government should fund part of the cost to ensure there is input from a clinical psychologist in every residential care home). Despite having done no marketing, we have more enquiries about joining our system than we can keep pace with. We are already used in over 100 children’s homes, and we have a growing number of local authorities who wish to roll out our pathway across their entire catchment. We are looking at how we train and license other clinicians to deliver the model both in the UK and internationally.

We have a great clinical team, a graduate project manager/admin, a fantastic professional network and a great product set. What is important to us now is getting the right person to drive the business side forward at this critical time. To do that we really need someone with business skills and experience, combined with a passion for making social change to take on a leadership role on the financial/business side of the company. We are therefore seeking an extraordinary COO who will help us achieve extraordinary things.

Who are we looking for?

You need to genuinely care about making the world a better place, and to share our goal of making a measurable difference to the lives of vulnerable children and young people. As a clinician CEO it is vital for me to have someone I trust to bounce ideas around with, who will ensure that we are on a sound financial footing to enable us to deliver our ambitious plans. You will be familiar with all aspects of the finances for running a business, have a good working knowledge of the UK social care system and be a dynamic manager, but with a willingness to turn your hand to other aspects of the business (from fundraising to recruitment to CRM) until we are large enough to take on a full team. You understand the value of evidence-based practice and you have a good awareness of the financial demands of the social impact sector. You are the kind of person that can nail down complex ideas and grand ambitions into concrete and achievable plans that will make genuine social change.

You will ideally be based in Derbyshire at our new Matlock office and will help to develop a team there, but with some travel to other sites. However, we already have a base in Milton Keynes that I visit fairly regularly, along with existing relationships and use of shared working space in North London (Kings Cross), so if you are the right person then these might be possible alternative locations, provided you are prepared to travel regularly to meet with me in Matlock and are comfortable using video chat in between times.

How to apply

If what we are looking for sounds like you, and you are looking for a new challenge, please get in touch and we can set up a meeting. Or if you know someone that might be the right fit, please pass this information along to them. Email lifepsychol@gmail.com to express an interest. No agencies or recruiters please.

Background information:

LifePsychol currently consists of a small clinical team who provide assessment and therapy services, particularly for children and families, and services commissioned by local authorities to support Looked After Children, adoption or families at the edge of care. Our Clinical Psychologists also provide expert assessments for the family court and to local authorities considering entering proceedings. We provide consultations advice on service development and service evaluations for social enterprise and third sector organisations. Our main specialist area is around attachment, trauma and maltreatment and how this evidence base can inform the care of children who do not live in their family of origin. We therefore provide training for adoptive, foster and residential carers, as well as health, social care and legal professionals, and have a network of associates who provide regular consultation into organisations.

However, our primary goal at present is nothing less than to improve the quality of placements for all Looked After Children in the UK. LAC are a particularly vulnerable group of children and young people because their needs are complex, and often include mental health, developmental difficulties, problems with relationships and behaviour. We hope to achieve this ambitious goal by training carers and implementing a new set of standards for care providers (PRIME) and through regular use of outcome measures (BERRI).

The PRIME standards are about ensuring that strategies carers use are evidence-based, individualised to the background and needs of each child, evolve as the child’s needs change, and are based on a thorough psychological assessment and a multi-faceted formulation of the child’s needs. We believe that having advice from a clinical psychologist to inform the care of all Looked After Children (and other children with complex needs) will both reduce stigma and improve outcomes, whilst helping carers to feel better equipped to meet the children’s needs. We have developed a training program and care pathway as one means to implement these standards for placements.

We have also developed a set of online tools for commissioners and placement providers to use to identify and track the needs of children in their care. The tools are known by the acronym ‘BERRI’ because they explore Behaviour, Emotional well-being, Risk to self and others, Relationships and Indicators of psychiatric or neurodevelopmental conditions that may require further assessment or diagnosis. We want every young person with complex needs to have a service that meets their needs in an effective and evidence-based way. We have therefore developed tools that allow us to gain a more holistic picture of children’s needs, to track how this changes over time and to target particular concerns and monitor the effectiveness of interventions to address them.

Our first data suggests that we can reduce concerns about children significantly within six months of using the pathway and tools we provide, and our services gain exceptional feedback from carers and professionals, but we hold ourselves to tough standards of evidence, and gather data about our effectiveness every step of the way.

Note: The BERRI questionnaire and online tools were developed to improve the outcomes for children Looked After in public care in the UK. However, the system is also applicable to those receiving other forms of intensive or multi-agency input, such as those on the edge of care, attending special schools, placed in inpatient services, secure units or involved with services for young offenders. The system would also be equally applicable in other countries, and could be adapted to other populations (eg adults using mental health inpatient services, people with learning disabilities, or those within the criminal justice system).

All change!

Someone once said to me that, if you can manage the stress, change can be an opportunity. They argued that a time of confusion is a good time to put forward ideas that could be seen as potential solutions, as nothing is set in stone yet. Derren Brown (the skilled TV hypnotist, cold-reader, sleight of hand maestro and showman) said something similar when he talked about how confused and stressed people are at their most suggestible. I think he said it whilst persuading bookies at the races that he had won on losing tickets, which was not something I felt was ethical to replicate (even if I had his skill-set) but I do have some anecdotal experiences of this being true. I remember a few years ago going shopping in early December and queuing up to pay in a very busy clothes store. I had a loyalty card which gave a discount for the event at the store, but when I got to the till I couldn’t find it. The poor cashier was on hold to the accounts department to see if they could find my details when, whilst making small-talk, I asked if the discount was the same as the student discount. The cashier then decided it would be easier to put my purchase through as a student discount (which did not require a card number), so that she could deal with me more quickly. Thus I got the discount without the card, and she was able to move on to the next customer. I could see that my comment had unintentionally introduced the potential for an easy win into her mind. Of course as soon as I left the crowded store I was able to find the card, but it made me think about the attractiveness of offering an easy option when the demands are overwhelming. I find this a reassuring concept to think about when the public sector organisations seem to be constantly in a state of organisational change, demands that exceed resources to meet the need, and a pervasive level of uncertainty and confusion! This idea that sometimes a suggestion with serendipitous timing could influence change in a positive direction offered an interesting alternative perspective to my pessimism about how difficult it can be to get even solid, evidence-based, cost-saving ideas accepted into practise (see previous blogs).

I’ve also been talking about the need for change in how I work in my personal development coaching sessions. I’ve previously blogged about feeling a bit burnt out by the emotionally harrowing content of some of my work, the need for me to get better at prioritising and how I am trying to get a better work-life balance. One of my motivations to start the coaching was my sense that I have so many plates spinning I have almost lost track of why I am spinning them and what my goal is. I wanted to re-evaluate what my goals were, and to find the joy in my work again. As I have begun to clear space in my life to reflect on this, I have recognised that my beliefs about what my career would look like have not really kept pace with changes in the public sector and in my own interests and ways of working.

At some level, my template for a good career in psychology was based on my Mum. She worked in child psychology and CAMHS, and was Head of Child Psychology for a county at the point she retired a couple of years ago. I had always assumed that was pretty much how my professional life would pan out. I had qualified in 2000, worked my way up the bands to make Consultant Grade and be part of the CAMHS management team in 2008, and expected to end up as Head of a Child Psychology service somewhere. In metaphorical terms, that was the train journey I bought a ticket for. But something changed when I had kids and went through a lot of stress related to the organisational changes when the CAMHS contract was won by a competing trust and we were TUPEd over. In the end I left the NHS and did something different. In the metaphor, I got off the train. My early plans for my company were very much based on wanting to replicate what I was doing within the NHS, but without the systemic problems I experienced in the NHS trust that I left. So in the metaphor I caught the bus, but I was still headed for the same destination. At various points I meandered, detoured to explore things I had heard about, joined groups to see the local sights, even hiked across country with my own compass, but underneath it all my destination was still the same.

Of course once you are going off the beaten track, sightseeing, hiking and choosing your own route, the journey becomes a bit more scary but much more interesting. In turn, the destination becomes less fixed and also less important, because it can continue to change and there may be steps beyond each destination to another. You can also grow in confidence and tackle bigger challenges and find new things inspiring, so you end up setting goals you had not considered at the beginning of the journey. Once I was off the train, I didn’t need to follow the tracks, or try to make my way by other means to where they led. I didn’t need to replicate CAMHS or to try to set up a LAC service outside the NHS, and I didn’t need to be Head of a Child Psychology service. Indeed I was offered an NHS post with this title last year, which was my expected destination, but I declined the offer. I learnt things about the post that made me concerned that I’d be jumping back into a train on a route where everything was running late and all the passengers were unhappy, whilst I was no longer afraid of being off the rail network and doing my own thing – in fact I had remembered how much I could enjoy the journey if my focus was in the here and now and not about trying to get to the destination ASAP. I started to think of myself as being a much more adventurous person and put my skills to use in much more flexible ways.

Sadly, the kind of NHS I envisaged spending the next 25 years in isn’t there any more, and the jobs at 8C and above bear a lot of the brunt of the change by having to take on the new political and financial pressures, whilst the lower banded staff continue to do much the same work (albeit with increased pressures of throughput and whilst hot-desking). There are good services remaining, and some people will still think that is the best career option for them, and I’m glad about that as I love the NHS and want to see it survive and hopefully thrive in the future with more investment. But for me it isn’t the only option any more. There are other opportunities for adventures outside of the NHS that hang on to my core ethics and values, and put my clinical psychology skills and experiences to good use, but without some of the constraints of the NHS. I can write my own job description, choose my own working pattern and be paid for what I do, rather than on a fixed set of salary points for a set number of hours. Perhaps surprisingly to me, I’ve learnt I’ve got competencies and ideas that are useful and marketable in lots of places. Despite the austerity in the NHS, I continue to have more opportunities and offers of work than I can accept, and some of these are quite well paid. In short, I have learnt that I can actually think much more creatively about what options for my professional life will make me happy if I let go of the template of how I expected my career to be.

With that insight, I’ve got a growing desire to start afresh and do the things that have most impact and bring me most joy. That means I need to look hard at all the options in front of me, and all the plates I have been spinning, and figure out which of those I want to focus on, and which I want to pass on to other people or drop. There may also be entirely new projects that I can develop because they are interesting to me, but I can recognise a future market or source of funding for.

There is big change ahead. But my business is small and agile, I’ve got an entrepreneurial attitude, and I’m lucky enough to have some interesting offers on the horizon. I’m in a position where I can embrace the change, so I am seeing it as an opportunity.

Confessions of a workaholic

Hi, I’m Miriam. I’m a workaholic.

I face that fact with insight that it is somewhat akin to an addiction. But there is no 12 step program for this (and I’m an atheist so it probably wouldn’t suit me if there was) and total abstinence is not an option. There is little around in terms of evidence-based intervention either. This might be due to the lack of stigma involved in working too much, and the way that having a job at all is a mark of relative success. In fact society somehow endorses overwork, and there is almost a culture of humble-bragging about how much we let work take over our lives. Our phones and computers bring us calls, emails and texts 24/7 and it is hard to know where work ends and our lives outside of work begin.

So let me start by describing the problem: I have too many plates to keep spinning. I take on much too much at work. On top of all the psychology work I am struggling to get on top of the invoicing and the finances of the business (I don’t really enjoy doing that side of things, but I haven’t found a successful way to delegate it yet). I bring work home. I work as if its a hobby by running a website, a blog, several twitter accounts and now a patreon service in which I offer personal development support to early career stage psychologists. I am making an app, developing an online outcome tracking system and writing a book. Plus I talk at conferences and do training. And I do court work. I provide supervision and personal development support. I sit on numerous committees and working groups. I fill my diary chock full of commitments and let the admin spill outside working hours. And I am writing grant applications (I’ve got one, part-written, on my screen at this very moment). But it is not just in work that my workaholism shows. I create little work-like activities to populate my life. We have some investments that I manage. I used to trade on eBay and at sci-fi fairs. Even giving stuff away to charities and freecycle takes time to organise. I do little fundraising activities for good causes. I’ve done up a series of houses (and even helped friends to do up theirs when I have spare time).I grow vegetables. Even the way I shop is influenced by my business brain, so I’m very conscious of relative prices in different supermarkets and I like to get reductions and offers.  There is a half-written novel too (but everyone has one of those, right?).

Since I’ve left the NHS to set up my business I’ve worked many more hours than I did before that. But even in the NHS I’d often stay late to finish admin, and I took on court work outside of my NHS hours. I’d guess I worked 40-45 hours per week then if I averaged it out. Last year I would work from waking up until the kids needed putting to bed, when I’d stop for half an hour to chat and then sing to them, then I’d make a meal and eat with my husband before resuming work again until I couldn’t stay awake any longer. I’d fit in bits of work (and catching up on sleep) at the weekend. There were many weeks I probably clocked up over 70 hours of work. And that leaves very little time for anything else.

I’ve come to think of the space that work takes in my life being like that expanding foam filler you can use to fill the gaps where pipes enter your home. At its worst, every minute of my time that isn’t taken up with something else gets filled with work, or work-like activities. The only spaces that are protected are for the things that I value more than work and have defined really clearly – the half hour in which I put the kids to bed is sacrosanct. As is an evening meal with my husband. If I have made arrangements with friends or family then work has to fit around. On the times when we go out for meals or do things as a family, I try to make sure work does not impinge. I’ve also tried to carve out time to get to the gym three times a week, and only miss this when working away from base or where there is an immediate deadline. Some things that waste a lot of time for other people, I have simply chosen not to do (for example, I haven’t watched any live TV in over five years now). But many things that should be prioritised are not. I stay up late and sacrifice my sleep pattern far too often. I work through meals. I miss out on relaxation time. I haven’t found time for my hobbies in years. I don’t take a full quota of leave. Nor do I have as many holidays as I would like. Plus I’m embarrassed to say I’ve taken reports to finish with on several UK short breaks with my family. Once we went somewhere without wi-fi and I ended up driving around and using the BT hotspots from domestic customers to work in my car for 3 hours to get a report in, because a colleague had sent me their contribution 2 days later than planned and it didn’t meet my standards without substantial editing.

So, given there was no risk of getting fired or not being able to pay the mortgage, why would I give work such precedence against everything else in my life?

I keep asking myself that, and its a tough question to answer. I am not hugely motivated to maximise my income and I’m not competing against someone else. I’ve never had ambitions to drive a porsche or own a huge house with a swimming pool or any form of status symbols – in fact I hate ostentatiousness. I don’t have a goal for turnover, or numbers of employees, to win a particular contract, or to take over the NHS. I just want to do worthwhile work that improves life for people who have been dealt a bad hand, in a way that is delivered to them for free and according to need. I want to spend my working time with people I like around me, and to have shared goals and achievements.

I think the things that motivate me to work hard are complex and interwoven. Part of it is my heritage, and the stories about the importance of work that have carried through the generations in my family. My dad rebelled against expectations to be a doctor, and has always been creative, which is a much harder niche in which to find success (he has written many children’s books and has latterly become a skilled photographer). He spent much of his working life as a house husband, dealing in antiques or doing jobs he didn’t like, and had a lot of time off with ME like symptoms when I was a kid. My mum has always been a hard worker and the main provider in my family. My maternal grandmother was a hard working single mother in an era and cultural group where there were not really single mothers, and remarried unhappily but wished she hadn’t (and probably impressed upon my mum at some level the value of supporting yourself and marrying for love). Plus my heritage is as an immigrant squared – my great grandparents/grandparents were persecuted Jews who earned their way up from nothing when they fled from Russia to South Africa, and then my parents came to the UK and built a new life here from scratch. There is a high value placed on taking advantage of the opportunity for a good education that people take for granted in the UK, and there are many examples of the value of hard work. The family is very well educated (my dad is the only one who didn’t finish his doctorate) and has implicit ethical rules about the kind of work that we do. I’d think about these as stepping up to the challenge, and seeking to advance knowledge or make people happier, rather than maximising profit or power. There is a definite drive to achieve, though no-one would explicitly want to pass this on to me and I know they would want me to prioritise happiness.

Another part is my moral values, approach to life and personality. Being a psychologist is core to my identity, but so is a sort of entrepreneurial view of the world. I approach everything with curiosity and a desire to problem solve. When it comes to issues that lead people to be less happy or achieve less than optimal outcomes, I genuinely love the process of formulating what is going on, designing innovative solutions that might be effective, evaluating whether they work and disseminating the results. I gain satisfaction from the intellectual challenge, being able to influence practise. I like getting positive feedback for good work, feeling that I have been helpful to others or had a positive impact on systems or decisions. I like the fact my reputation means I am constantly in demand – interestingly in the public sector a waiting list feels like a sign of failure, of not keeping pace with demand, whilst in the private sector it is a marker of success as people are prepared to wait to see you, and the demand for your services exceeds your capacity to supply them. I also feel that people who are gifted with the resources of resilience, intellect, empathy and knowledge should put them to good use, and that the value of my life and the legacy I leave behind will be the impact I have had upon the happiness of others. I’m not a perfectionist, but I do set myself high standards. Finally, it is hard to turn down work that is so badly needed or that you feel might be done poorly in your absence. I know that sounds grandiose, but I’ve seen really bad examples of court reports that led to ill-informed decisions, and it adds to my sense of responsibility to do things well.

I also think that the nature of being self-employed, and of feeling responsible for employees has added to my pressure to work. I feel like I need to put the effort in to establish the business, to ensure we have enough cash flow to pay everyone, and to feel I am pulling my weight. I also feel there is something difficult about turning down work that pays amounts of money that seem almost obscene when compared with what some of the population have to live on. Doing this kind of work is such a privilege compared to having to work in a factory or doing hard physical labour or monotonous office work, or having to do voluntary work experience to claim their benefits. I compare myself to someone trying to eke out £150 of job seeker’s allowance to pay for a fortnight of food and fuel and think how bizarre it would seem to them that I had turned down work that would earn that in just a couple of hours. Or I compare what I earn now to myself as a graduate psychologist earning £9500/year and self-funding an MSc from it. I think about how that extra money could keep on the assistant who really needs the work, or pay for us to have a holiday, or a cleaner, or how far it would go if donated to a charity.  It just seems so ungrateful and lazy not to be willing to do the extra work in that context.

It is also to do with how I think about my own work. I always try to help others and say yes to requests unless I have a reason to say no. I’m dreadful at thinking “oh it will just take me a couple of hours” and taking on new responsibilities without being realistic about my existing commitments. I don’t put sufficient value on my time. And I hide the amount of work I do from others (and myself) by flexing my working pattern. I’m a night owl. I can work until I get things done, into the small hours of the morning taking advantage of the quiet solitude that gives me, and being self-employed and having a sympathetic partner I can often work a late start into my week or lie in at the weekend to catch up. But it makes me tired/hungry/cold (which are all very connected for me) and sabotages my daytime activities if I do it too much. From lying in rather than being up with the kids in the morning, to being grumpy and half-focused during interactions later in the day, there is always a price to pay. But my tendency to put things in to this quiet time, or to need it to catch up with things I have taken on means that I don’t stop at bedtime, and I certainly don’t stop in time to wind down for bedtime. I don’t think it makes me a very good role model. My kids ask why I am up late at night, or sleep in during the morning, and I feel embarrassed that I haven’t organised my time better. My colleagues are used to me taking work home and end up adding things to my calendar to fill up all the gaps, reinforcing the pattern that the 10 hours it takes to write a court report is outside of my working hours, and that no admin time is scheduled for writing bids, contributing to committee work outside of meetings, catching up with email or making calls.

Ironically perhaps, my internal sense of myself is of a lazy and disorganised person. It has been interesting to me to have friends, colleagues and online folks reflect how they perceive me as hardworking, organised and successful. The contrast between my sense of self as never doing enough, and the external perceptions that I do more than is necessary is something I have been increasingly reflecting on. I recognise that my pattern of work is quite masochistic at times. I’m also aware that my expectations of myself are unrealistic and can’t be sustained. Overworking means I end up feeling like I end up with no down time, or at least very little that is entirely disconnected from my professional role or being a mum. I sometimes hit a kind of gridlock where there are so many demands I don’t know where to begin and end up doing none of them! And, like the emotional burnout I wrote about in an earlier blog, this has to stop.

A previous supervisor once talked to me about needing balance between multiple roles as a professional, a parent, a partner and a person. I’m trying to take stock and to chase work back into working hours so that I can focus on the other roles. I think they get more and more neglected as I go down the list. But kids grow up fast, and time with loved ones is precious and shouldn’t be put on hold for some imaginary future point at which there is more time. And I need to also find better ways to care for myself, so that I am happier and have more emotional resources to share with those around me. No more postponing going to the optician or physio. No more working through lunch, and no more super-late nights. I need to set aside time in my diary for all of my work commitments, including those that are currently invisible, and to prioritise better amongst what I take on. Instead of being pulled in all directions I need to work out where my highest point of contribution and greatest enjoyment are, and concentrate more of my efforts in a single direction. I need to have firmer boundaries and say no more often.

I read an article recently about a man who was diagnosed with cancer and given a very poor prognosis who then made a very positive response to treatment. When his cancer was treated and doctors said he had returned to a normal life expectancy he said that the experience had given him an unexpected gift – the insight that time is a precious and finite resource. He recommends that everyone thinks about what they would do if they had only a week to live, or only a month, or only a year, or only five years and identifies their priorities for this time. He points that at best we only have the remainder of our lifetime to live (in my case, probably another 50 years) and that now is the time to do the things that are the most important. So many people on their deathbed look back wish that they had recognised what was really important while they still had time, but we have this time ahead of us, and the option to choose to use it wisely. So whilst I have time, I am going to work out how I want to spend it. And that doesn’t involve work filling up all the gaps in my life. I suspect it involves more cuddles, more singing, more making things and cooking. More time socialising. More walks in the countryside. More holidays and travel. Regular exercise. Relaxation. Going to watch gigs, films, comedy and shows. Finishing my Adventure Diver certification. Making a mosaic. Laughing.

Work isn’t really so important. It doesn’t have the right to crowd out all the fun.

Sifting through the hoard

Over the years I have watched “a life of grime”, “my hoarder mum”, “life laundry” and “how clean is your house?” and saw hoarders on TV whose homes were filled from top to bottom with the detritus of their lives. The homes were unhygienic and bursting at the seams. Some were infested with insects, mice or rats. It was obviously problematic. I’ve read http://inheritingthehoard.wordpress.com/ and been curious about how some people reach the point they just can’t throw anything away.

I’ve done assessments with families who live in dirty cluttered spaces, filled with what is perceived as rubbish by outsiders but to them are mementos of loved ones who have died, have some intrinsic financial worth, or are imbued with sentimental value (or in the case of one or two people with more unusual thinking, with feelings that would be hurt if they were discarded). I’ve wondered why they can’t see the risks this is causing for them and their children, and realised how habituated we become to our own environment.

And each time I empathise because I can see some of those traits in myself. I collect things like art deco pottery and art nouveau metal or glasswork. My husband collects vintage Star Wars toys and retro video games (along with containers overflowing with consoles, cables and controllers). I have boxes and jars filled with ribbons, buttons, shells, stones. I have various hobbies that accumulate future materials (from pyrography to mosaics, silk painting to silver polymer clay, to making glass jewellery and other small items in a miniature kiln). More than that, I don’t like to throw things away if they could potentially be of use to someone.

I justify some of it with intellectual rationale. I loathe wastefulness, and the disposable consumerism that characterises the modern age. I can’t bear that everything has become disposable, is burning up the planets resources in manufacture and then going into landfill at an ever greater rate. I’d much rather reuse, repair and recycle whenever possible. I want to teach my children about being frugal, and about finding enjoyment in creative activities rather than consumption. The dress that tore has such pretty fabric that could be used for another project. Last year’s Christmas cards can be clipped with pinking shears into this year’s gift tags. The pretty wrappers from these chocolates could go in the making box to use in craft projects. The trousers you’ve grown out of should go to the charity shop.

I was also an early fan of eBay and Freecycle, and realised that almost everything has value to someone else. So I would sell items worth more than the hassle of posting them out to the buyer, and freecycle everything else. From the extra items of pottery I picked up at car boot sales, to clothes we grow out of, to the wood flooring that came up after we had insurance work done in the house it would find new homes. We’ve sold books, toys, video games, collectables, antiques, electronic items, pushchairs, car seats, cots, jewellery and furniture. We’ve given away spare fence panels, a lawnmower, a microwave, two TV’s, a hi-fi system, bags of used jiffy bags, metal car ramps, two sofas, carpets, even 56 baby fish from our pond. We take clothes and toys to the charity shop every 4-6 months. And the amount that went into the bin reduced. I also changed my shopping patterns to include reduced items to prevent them ending up going to waste, and to try to reduce the packaging used. We also try to recycle as much as possible of our rubbish (our council collects paper, card, plastic containers, metal, glass and garden waste and we compost food waste in a “hot bin” to fertilise our home grown vegetables).

The problem is that my heap of clothes for taking up, taking in, letting out or repairing outpaces the time available for me to sew. The collecting of the hobby items exceeds the time I give myself for creative projects. The piles for eBay and Freecycle grow when I don’t have enough time to spend on that kind of internet busy work, and we haven’t quite got the hot bin working optimally (by which I mean that in the year we have owned it we are yet to produce any viable compost, perhaps because we have not added enough shredded paper and chipped bark to keep it aerated). And I end up keeping things I love even when they are pretty much worn out and we can afford to replace them, from a favourite top where a hasty encounter with a door handle punctured the sleeve to comfy but scruffy shoes. My disposal threshold has become too high.

Steadily over time the amount of stuff we aren’t using in the house has increased. But we are lucky to have a fairly big space to live in, and plenty of hidey holes for storage, so this hoarding has not been so obvious. We also have high standards of hygiene and the wealth to supplement our own tidying up with weekly professional cleaning, so this doesn’t feel like the kind of hoarding that I’ve seen on TV. We just have places in the house that are filled with stuff. There is a heap of slightly or un-used hotel toiletries in the upstairs bathroom because I don’t like the idea that they would be binned by hotel staff if I didn’t take them home. I have various repositories of lovely smellies and candles that seem to accumulate whilst we use more pragmatic alternatives. There is a chest in my bedroom of fabric, and boxes of threads, buttons, ribbons and beads. There is a filing cabinet in the garage filled with art glass, and an old sideboard filled with items for my future mosaic project, along with the tools and junk that garages usually accumulate. The extra bedroom has become a den filled to the brim with video gaming stuff. There are boxes in the loft with art deco pottery item that don’t quite fit the collection I display in a cabinet in the front room. There is a collection of StarWars toys in what used to be the airing cupboard. I have a box of my old school work in the loft, and boxes of the art work the kids have made. We have seven bookcases full of books, plus half a cupboard of activity books and magazines that haven’t been completed. The dining room holds piles of items we are planning to sell on eBay or Amazon, or give away on Freecycle, along with craft materials and books we haven’t found a place to put away. And in the lounge there are heaps of paperwork that need filing and things that need taking to work, or returning to the place we bought them.

Its too much. And it is beginning to feel contrary to the logic that made it accumulate: Things need to be useful, not kept for the sake of it. So, starting this weekend, we are going to go through the whole house top to bottom and clear out the clutter. This time, to make sure we do it properly, all the contents of each room are getting heaped in the middle and then put away. Each item can only stay if we use it or love it and it has a place to go. Things that we love but that need fixing can only stay if they will be repaired before Xmas. Everything else needs to go in the bin, or on freecycle, or to the charity shop ASAP.

Its another reminder of how the dividing line between pathological and functional is blurry, and often a matter of socio-economic status and which side of the table you sit. In a tiny home without the help of a cleaner this would be a problem level of hoarding, in my lifestyle it isn’t, just as the hedge fund trader can fund a drug habit without the pitfalls so common amongst users of the same substance in poverty. It seems to me that hoarding is a basic human survival instinct (to store what might be useful if next season is not so abundant) that doesn’t translate well to the modern context, where supplies are available 24/7. Perhaps some people have stronger triggers to hoard, like not wanting to let go of a loved one who has died by dealing with their possessions, or have different perceptions of the standards that are normative in terms of clutter and cleanliness in the living environment. But it is clearly another trait that exists along a spectrum, with a somewhat arbitrary threshold at which is is considered a problem or symptom of poor mental health. And it reminds me once again, that there but for fortune I could be receiving rather than providing mental health services.

So here I sit, overwhelmed by the chaos that is normally hidden in the storage holes of my life. I’m already embarrassed by the sheer volume of stuff involved. Crates of excess coat hangers, hundreds of elastic bands, pens and mouse-mats promoting medication, heaps of recyclable packaging from parcels, toys related to developmental stages the kids have long since passed. But its a therapeutic process to sort it out, and I think it will be a psychological as well as physical weight lifted when it is all gone.