life

Give and Take

I’ve run the clinpsy forum for 18 years, and before that I spent a couple of years as a moderator on a precursor forum. I’ve compiled and/or written about 200 wiki posts that have been viewed millions of times between them. Some individual posts have had over 100,000 page views – the most popular being a giant list of interview questions I compiled, a post about transference and counter transference, and one about keeping a reflective journal and one I wrote on clinical vignettes, followed by my post about formulation, and one about clinical interviews. There are also popular posts such as one about what to do with a low degree mark, a more general post on reflective practice, one on supervision and posts about preparing for assistant psychologist and IAPT interviews. The site peaked at about a million page views per month, but has slowed a little as technology has moved away from forums towards WhatsApp groups, and various people have tried to cultivate this audience via social media (often selling products and/or services).

I’ve never really seen running the forum as potential source of income. In fact, it has been a huge drain on my resources – I spent an hour a day for a decade building the content and community, and I’ve paid the server fees, programming, design and other costs out of my own pocket (subsidised at times by a trickle of advertising income). Even now I have to check and activate the new members, respond to emails and PMs at least 2-3 times per week. On the other hand, I have saved a little bit of money on advertising, I’ve been able to promote my own book without cost (and various courses and jobs offered by people that I know). It has given me reach that I might not have had otherwise (I’ve got about 10,000 followers on Twitter, over 5,000 on LinkedIn and this blog has had over 100,000 reads). And I’ve saved a little time in accessing information or publications. So whilst it has cost me about two years of full-time work, and about £5000 overall (plus the cost of the clinpsy URLs and the time spent on social media, but those aren’t constrained to this purpose or audience), I don’t feel like the time has been wasted.

Maybe that is because I don’t do it for the money. I’ve mainly seen it as a way to undermine the added value of nepotistic networks, where information was kept amongst a privileged few who had access to CPs. I wanted to democratise the profession, by puting that information into the public domain, and allowing equal access to sources of support for people from all different demographics. I quite intentionally undercut those who marketed to this group, by offering forum membership and access to various activities for free, and by asking only for a charitable donation for the various webinars, training days, professional development workshops and reviews of applications that I offered (with the level of donation being recommended, but the option being available to pay less or even nothing for people of low means or groups who have been traditionally excluded from the profession). That has also led me to raise thousands of pounds for charities like UNHCR, Magic Breakfasts, food banks, refugee support, and various other causes from replacing the broken electronic whiteboards at a local primary school to dementia care, to educating girls in Africa.

I also get the intangible reward of the people who thank me for the impact that the forum and/or my input has had on their lives. Their notes that say that my feedback made all the difference to them gaining a job or a place on training. Or that my workshop helped them convey their competencies more confidently at interview, or find the next step in their career. It means I am quite widely known in the profession, which builds trust and reputation. And, perhaps most importantly, there are people who have met me through the forum have later become friends, employees and colleagues.

At a few points, people have expressed interest in buying the forum off me. Sometimes that has been an easy no – like when the offer came from the owner of the profit-making travel agency that masqueraded as a charity giving people psychology experience in Sri Lanka and other developing nations. But there have been more benign offers, and now I am so preoccupied with my business, and the other moderators who helped me run the site have mainly fallen away, I do feel like the time and resources I have available to pour into it is limited, and there might be advantages in bringing new energy to the community. So I am torn between a plan to reinvigorate the community, and the idea of handing it over to a new owner.

I also wonder about the balance of give and take, and whether passing on ownership would relieve me of an undue sense of responsibility. After all, there is only one of me, and over 9000 members* and I’m also spinning quite a lot of other plates – I’m Mum of teenagers doing their GCSEs, we are in the midst of building work, and I run my own business which could use my time five times over. There is also something strange about running a forum that feels like the service I provide is taken for granted, assumed to be financed by a professional body, or is treated like public property. Sometimes people have quite unrealistic expectations – demanding immediate responses to messages, sending grumpy emails if their account is not activated right away, breaking the minimal simple rules, or complaining about moderation. People post adverts or self-promoting content without permission or payment (even though our charges are minimal and support the costs of providing the forum). It is as if they believe it is their right to post on the forum to get free promotion for their blog/website/book/course or whatever.

It sometimes feels like a lot of people put very little in but expect to take out as much as they want – asking questions but never contributing to any other discussions, or signing up to request a form review or to apply for a place on a low-cost event without ever contributing to the forum or being part of the community. I like to raise money for the charities and to give people access to information, but each form review takes me 30-40 minutes, and I currently have a queue of 47 requests – which will take about a week’s working time out of my weekends and evenings over the next month. I’d be much better off financially if I donated £1000 to the charities myself and spent the time on income generating work!

But the alternative is to give those selling services to aspiring psychologists an open market to exploit, or for me to have a paid tier of forum membership or to sell products and services, which doesn’t sit right with me, as it reinforces the privilege filter that has always biased our profession towards middle class, able-bodied, white women. Given I don’t want a website and forum full of intrusive advertising, and I haven’t got money to throw at it, the alternative is running the forum on a shoestring – which is fine when we have lots of volunteers contributing to keep the discussion lively and assist with the admin, but more difficult the more of the work I need to shoulder alone.

There are echoes of the same theme in decisions I need to make about my business. As we scale I need to decide whether we continue to bootstrap our growth, or we borrow or seek investment to grow faster (making more impact for more children, but with the cost of being pulled towards earning enough to repay a loan, or delivering a financial return for investors). I need to weigh up the value of locking in the mission to the company structure, versus optimising the business for investment. My gut instinct is to lock in our values with a pledge to prioritise impact, and to donate a percentage of profit above a certain threshold to a charitable foundation that can offer access to the tools to those that can’t otherwise afford them. But it might be that keeping a traditional company structure and taking on investment allows us to reach more children and make more impact to a wider population than we would by being too rigid and narrowing the pool of investors that would be interested.

So I need to think more about how I value and prioritise my time. I’m not sure I owe anything more to aspiring clinical psychologists than any other member of the profession does. So I wonder why I felt obligated to take up this mantle, and continue to stubbornly carry it? And why am I willing to sacrifice my leisure time, or the time I get to spend with my family or on my business, to do things with minimal personal benefit? Whilst I love that I live my values – and the way they permeate almost everything that I do – they do have costs, and I think I probably need to prioritise myself and my family a bit more. I’m not sure I’ll look back on my deathbed and think “I wish I sank more time into that website”, or “if only I had offered more professional development support to aspiring psychologists”, or “I should have achieved more with my business” rather than “I should have spent more time with the people I loved, given more focus to my health and wellbeing, and seen more of the beauty of the world”.

*I haven’t pruned off the dormant accounts for a while, so once I do this may well return to the approx 8000 figure where it has stabilised for the last decade.

Challenging times

Time for another update, but sadly not a positive one.

On the good side, I got new accountants who sorted out the mess and applied for my tax rebate (though it is still to materialise), and moved to a new online system for keeping my financial records which is great. My AP got onto training and left in September. The diabetes project was Highly Commended in the FSJ Efficiency awards. We had lots of positive interest in what we were doing and put in 3 substantial bids. I’ve been invited to speak at a range of exiting national conferences, and I’ve been involved with quite a lot of national committees. The book has sold about 1000 copies and has received some lovely reviews.

The bad news is that none of the bids were successful, and none of the interest has translated into a contract for our services (yet). Legal aid fees for court work have come down another 20% and the maximum hours per case are also being squeezed. A high proportion of invoices are being queried, which generates extra work, and quite a few are not being paid at all (due to solicitors going out of business, or problems between them and the LAA, or disputes about who is responsible for the fee) as well as loads taking 12-36 months to pay. Although we have a few therapy cases, half of them are at our subsidised rate that barely covers costs. The diabetes project may be commissioned by the CCG or hospital trust at some point in the future, but there are no guarantees, and any contract definitely won’t be in place before the new financial year. Our finances were already tight, and I don’t really believe there will be a contract until it is signed off, and I can’t afford to keep the team employed until it comes through.

The CCG say that our service is too small to separate from the diabetes contract. The NHS trust made positive noises in public, but in private it was a different story. An NHS finance director told me that the trust would not consider subcontracting our service because it reduces crisis presentations that are income generating for them. That’s horrific to my thinking – that they have perverse incentives to want people to end up in diabetic comas, or with blindness, amputations or suicidality if it makes them money as an organisation. So I have to count on the service closing.

The reduction in work would mean that staffing costs will exceed our income quite substantially from January (about £5k/month) so it looks like the business has to shrink from me plus 4.5 whole time equivalent to me plus 1.6 whole time equivalent as quickly as possible, with the potential of me returning to work as a sole trader or taking up employment elsewhere in 3-4 months time if we don’t secure more work.

This is obviously gutting, and makes me feel horrendously guilty and stressed. I’ve been so upset about it that I’ve pretty much wanted to hide under my duvet and cry, rather than try to continue working. Its just horrible to feel I’ve let people down (even though I know logically that it isn’t my fault, and that I’ve always been clear with people that it is a small business and doesn’t have the safety net of the NHS, and that many of the staff were on fixed term contracts related to specific projects anyway). Of course, being self-employed I can’t just sign off sick with stress, and have to see through the court work I’m doing, but I can’t wait for some time off at xmas…

Basically, I’m having a bit of a ‘why am I doing this?’ moment, and I don’t really feel like I know what my goals are any more.

Finding my own way forward

It feels like so much has changed even over the last five months since I last posted.

We moved into the new offices, furnished them and got fibre-optic broadband and unlimited phone calls. We’ve got a lovely therapy room, a reception, a kitchenette, a loo, an office where most of the team sit, and my office which can be used for consultations and appointments when the other room is busy. This suits us so much better than being in a giant serviced office building as the space is ours alone. There is something quite remarkable about being able to do things immediately and autonomously when compared to how long each process would take in the NHS.

The team now consists of me, a part-time operational manager, a full time nearly-CP (just needs to get thesis corrections signed off and HCPC registration), an AP, an AP(R), a general assistant (psychology graduate), a part-time admin (the full-time one didn’t work out), and a part-time CBT therapist who contributes to one project. We are recruiting again, as demand still exceeds supply, and hope to get someone (or two) to join us from a clinical course as they qualify in September. It feels like we are on a path of steady growth, but it is actually quite tricky to ensure that we balance workforce and work. I’m learning a lot more about running a business, and also learning to delegate to my team. We have set up a social enterprise company* to split off the provision of therapy and certain other projects from the court-work focused limited company. We have a new local accountant helping us get our more complex books in order.

The research aspect has also really taken off. We have won a Health Foundation Shine award, which gives us £75k to offer and evaluate a psychological therapy service to aid treatment adherence for diabetes patients at the local hospital and a small parish council grant to run and evaluate a group for expectant mothers and a perinatal group. There is potential to expand the hospital pilot to other areas over the next year. We are also going to apply for an ESRC grant in collaboration with a local university. We’ve formed connections with lots of the voluntary and community organisations in our local area, and have put in some small grant applications for various projects. We’ve also got talks going on with various social care and health organisations about delivering consultancy, assessment and therapy services, and enquiries about many other things we have mentioned. We’ve had a few therapy referrals from various different sources, including some self-funded private clients, and are (frustratingly slowly) becoming registered as a provider for one of the major health insurers. The court work continues to flow in as our main income too, with ever more complex and interesting cases, so it feels like I need to be careful we don’t grow in too many directions at once, and focus on the interface between our passion, our expertise and what is marketable.

Meanwhile I’ve got my book coming out next month which hardly feels real! We are planning to have a launch event of the new social enterprise coupled with a book launch on 1st March and do some free talks for various groups of professionals at a local venue, which should be fun. The publishers are keen for this to be the first of a series, but I need to carefully consider what (if anything) to write next. I’m toying with the idea of writing up some papers and a book (and perhaps even a phd) on an area of research that’s been particularly interesting to me, but it rests on getting another grant and/or some paid academic sessions and deciding this is worth the time commitment compared to other projects. I’ve also joined the committee of the BPS faculty for children, young people and their families, and the FJC/BPS reference group for psychologists as expert witnesses as well as my on-going role with CPLAAC. Its probably a bit much all at once whilst running two companies, but I value each role for different reasons. It has also brought me into contact with a new peer supervisor, which is great.

Most important of all, I’m still enjoying it! I’ve built a fantastic team of people who I enjoy working with each day, and I’m working with the issues that are of most interest to me, and I’m keeping a balance of activities but all with a focus on quality. It turns out that CP skills are quite marketable, if you are creative about it and have a good reputation and network. Although I’m still weak at the financial side (invoicing, chasing late payments, keeping good records of expenses to put on tax returns, etc) I hope this will be a mountain I conquer this month, with a one-off blitz and then keep under control by devising ways to delegate aspects of this to others in the team. We still seem to be ticking over though.

My other aim for this year is to get a clearer vision of our destination, or at least our direction of travel, and then think about the company structure that will be necessary to achieve that vision. I’m quite obsessional about the business to the point of being a bit of a control freak, and so I find it hard to delegate and not to be involved with everything, but this will be necessary as we grow. I think this will get easier as the experience of the team grows and I test out what other people can do well without me. Hopefully this will allow me to have a better work life balance, where I can fit in more time for leisure, exercise, relaxation and sleep – not just work and the kids!


*A social enterprise is a company that is run for the purposes of doing good. So either it can be a normal business that donates the majority of its profits to a good cause, or it can be a business that does something worthwhile where the majority of the profit is reinvested in delivering that work.

Into uncertainty…

Well, we are now in a fog of low morale and lack of information, in which the rumours suggest that many CP posts will be down-banded and the current post-holders given only limited pay protection. We’ve got an initial meeting next week to hear what is planned, but I really don’t expect we will hear the truth until our posts have transferred over. It seems inevitable that there will either be redundancies or an attempt to avoid paying out by hoping that with down-banding people will seek jobs elsewhere, so everyone I know is considering their options (and regularly checking the job pages).

Personally, even though I am one of the people with least commitments to hold me here (as I don’t have kids in a local school, or a partner who wouldn’t be willing to move, or a house in negative equity) I’ve felt much more impact than I expected. I’ve lost motivation towards my work – I’m reluctant to get up in the morning, I’ve let my admin get behind, and I’m not doing the extra hours I normally do. In work I feel like I can’t make long term plans, so its really hard to think about the scoping exercise I’m supposed to be doing as part of the induction for my new post.

However, its also opened up a whole set of new ideas – if I’m not anchored to this job in this location then my husband could look for a job that he might like better than the one he is doing at present, or we could build a house on a Scottish Island, or I could have a career break and have babies, or I could turn my private court work into a proper business. This means it is harder to refuse requests for private work, in case this becomes my main source of income over the next year.

My mind is constantly wandering away from my NHS work and considering other possibilities, like whether it is worth finding a way to appeal the decision, or whether we should be working together to create another option like contracting directly with social services. It feels like as an individual I’ve lost my focus, but also that I’m in an organisation that has lost its focus. How can this be good for the NHS compared to the dedicated focused team we were a couple of months ago?