Should you go into private practice as a psychologist? with Thomas Gourley Trainee Clinical Psychologist - DClinpsy

Thomas Gourley (: 00:00:00

Coming up on today's episode of the Aspiring Psychologist Podcast, I talked to Dr. Marianne Trent about her journey from the N H Ss into her own private practise. We drop into Marianne starting third year of her doctorate, and we go through the journey into qualification through some years working in the N H S service as a qualified and then blended and eventually full-time into private practise. Talk a little bit about standardised ways of working, the skills and knowledge, and also how it feels and what kind of person maybe would succeed in private practise. We cover a little bit of the pros and cons including what both private and N h s can potentially uniquely offer for clients. And we also finish with some kind of big old reflections on the future. Word of warning, this episode is a little bit longer than usual, clocking in about an hour and 20 minutes, but obviously you can look in and out of that at your leisure. So thank you for listening. Hope you enjoy it and see you soon.

Jingle Guy (: 00:01:07

If you're to become a psychologist, then this podcast, you'll podcast with Dr.

Thomas Gourley (: 00:01:36

Hello and welcome to the Aspiring Psychologist Podcast with Dr. Marianne Trent. But wait, I know what you're thinking. This isn't Dr. Marianne Trent. Who is this guy? Why is he here and what's going on? Dear listener, were we not allow me to explain? My name is Thomas Gorley, and aside from lots of other things in my life, I'm also a trainee clinical psychologist. A few weeks ago, I was a guest on the podcast, and Mari and I talked afterwards about topics for future episodes. I said I'd be really interested to hear an episode about working privately and Marianne's journey from the N H Ss into her own practise. Marianne agreed that this would make an interesting topic, but what might not be too interesting for listeners would be in Marianne's own words to listen to her waffle on to herself about her own career. Instead, she suggested that it would be far better to be interviewed herself.

(: 00:02:30

And so the pyramid has been inverted, and the former podcast guest becomes the current podcast host. That's me. So that's what we're going to do today, and I'm going to ask Marianne lots of questions about her journey out of the D Cline into her qualified career, and then her journey into private practise. And we're going to make some kind of general comparisons and maybe a few specific comparisons about those two different career paths. But first, it's Declan application season, of course, so we're all ready to go. One thing that we need to remind you of is that the clearinghouse will contact your referees as soon as you save them on your application form. That means that they will be contacted before you even finish your application and submit it. So quick note, make sure that you get consent from your referees before you add them and save them on the form because clearinghouse will take that as consent and that they're okay to contact them. So content first and they will get contacted before you've submitted your form. So without further ado, welcome to the Aspiring Psychologist Podcast, not with Dr. Marianne Trent, but me, Thomas Gorley. And today's guest is non other than Dr. Marianne Trent. Hello, Marianne. How are you?

Dr Marianne Trent (: 00:03:57

Hi. I loved that. That's so fun. Thank you. Very, very pleased to be here, and I feel like I'm in very capable hands. Thanks.

Thomas Gourley (: 00:04:06

Good. So I'm going to drop straight into it and I'm going to take you back to the start of your third year and final year of your doctoral training because I guess that the start of the third year is probably also the start of the end of the training, and therefore maybe a time where trainees naturally start to think about what's going to happen post qualification and what kind of routes they want to take, maybe what services, maybe they're thinking about, what placements they might have wanted during third year and how that might lead into post qualification or not. So I guess to start, take us back to the start of third year. What were you doing and what were you thinking about post quality?

Dr Marianne Trent (: 00:04:54

Okay, great question. So in the course or on the course, should I say that I did the third year is broken up into two placements, two specialist placements that you really start to pave the way for probably in year one, really. And my first specialist placement was in a wonderful, wonderful service that's since been disbanded actually, unfortunately. But it was a systemic and family therapy service offering solution focus. But also there was proper family therapy rooms in there. I dunno if you or anyone else have seen them, but they've got one-way mirrors and phones that you can talk through and things like that. So it was in there. But then I also did had some clients for brief solution focus where you'd actually only offer appointments every four weeks I think it was. So you're really setting achievable, realistic targets and goals between, but it was also a self-referral service.

(: 00:05:59

It's like they were doing all of the really great stuff and also once a week on a Wednesday lunchtime, they'd do a drop in for any difficulties you were having. I think it wasn't just linked to children, but often it would be children or parents that were brought in. I can't quite remember. I think it might have been a specific family support drop in. So literally you could come half an hour before, give your name to reception and then be seen for 20 minutes with a qualified psychologist to think through your difficulties and come up with a plan. And then as a result of that, the clinician who'd seen would then write an assessment report and send on any referrals that were needed. So you didn't hold that as a caseload. And if they wanted to be seen again, they could, but actually people didn't tend to.

(: 00:06:48

It was such a wonderful way of working, and I learned so much and not even knowing anything other than someone's name before you see them. I really learned how to think on my feet and how to think about our core skills as psychologists and building rapport, rapport and trying to also probably interject when things are getting too content heavy to think actually, we've only got 20 minutes. If by any chance they were the only people that turned up or there were other clinicians, there was always other clinicians. But if it was a quiet time, then potentially you could go up to an hour. But really the idea was that in that hour you were seeing three clients and it was wonderful. So that was my placement there. And that was supervised by a clinical psychologist, and it was a very big team actually. And I think even trainee wise, there was a trainee room up in the attic and was, I think there was at different times of the week, there was probably four or five of us, so it was very busy, but I learned a lot.

(: 00:07:56

And then placement six was a dynamic placement, psychodynamic brief, dynamic interventions, which was something I was very interested about in my first year. But actually as I develop my confidence and you just create new interests and new ways of being, because I see placements as a way of trying on different stuff that fits. And actually by the time placement six came, I was much less interested in dynamic and probably I learned loads. It was a great placement, everyone was really lovely to me. So I don't want to talk down that placement, but certainly because of how long it takes to get into placement six, my interest for that, were less strong at that time and I haven't worked dynamically since. But I guess what I love about our work is that the theory is all up there still, and sometimes with our integrative way of working, sometimes it will just fit and I can weave in some more dynamic ways of working.

(: 00:09:02

But of course, alongside all of this, you have a personal life as well, don't you? And you've got cohort stuff and you've got a thesis. So there was a study block in between placement five and six where all sorts of things happened. For context, it's when William and Kate got married. That's that sort of time, it's that long ago. And that was the end of my study block. I seem to recall because the rest of the world was watching the wedding and I was beavering away on my laptop thesis. So yeah, there was lots on my plate, but actually personally, I was incredibly fulfilled and happy. I'd been living in my new house, which is not this one for a year, and I'd been with my boyfriend, who is now my husband. We had met in the first two weeks of my year two study block, I think. So that's kind of, yeah, I started the course single and then went on the Coupledom journey from year two. But yeah, that's a very long answer to your question. Does that answer it? Does that illuminate some of what was going on for me?

Thomas Gourley (: 00:10:18

Yeah. Yeah. It gives us a good idea of where you're at. I'm wondering, of course, both of those placements, I'm assuming were in the N H Ss as they tend to be, although I'm aware that it's possible to arrange the geo placements on some courses privately. So getting towards the end of your time on the doctorate, what were you thinking about qualification? What did you have a job secured before you'd finished? As I'm aware, most trainees I've met have that lined up. Was that in the N H S? And either way, what was it doing?

Dr Marianne Trent (: 00:10:58

Okay, so to set the context, we're talking about 2011 when I qualified and due to some kind of financial shenanigans involving various banks and mortgage companies, including Northern Rock, which no longer exists, there was a recession which was in full swing at that time. It didn't feel as bleak as the 2023 landscape. Actually, we hadn't also had a global pandemic, but at that time, actually, there seemed to be cuts across services and there were very, very few jobs available. So of my cohort of what started as 15, but finished as 16 due to maternity leave shifts from the year above, only I think two people had qualified jobs to go to. When the course ended in September, 2011, it started to creep up. Wow. Yeah, it started to creep

Thomas Gourley (: 00:12:04

Up. I guess that's unrecognisable that situation to trainees now where you might be the only person interviewing for the job, you might be the only person applying for the job. So yeah, that's a big change. Imagine, to be honest,

Dr Marianne Trent (: 00:12:21

Honest finding the jobs to apply to was the problem. There just weren't any, quite often trainees might even get jobs in their final year. Sometimes services will wait almost a year for the right candidate. But it was just like to begin with, it was like, hmm, there's not really many jobs around. Is there, I wonder when they're all hiding, oh, I have got bills to pay. But actually as it went, what happened is that basically probably all of that cohort across the country began to widen their search. So I ended up in a role that was further away than any of my placements had been. Even though the way placements are allocated, I never got a placement that was right near where I lived. I think my shortest commute was 15 minutes. So my longest during training was probably 50 minutes, but my qualified commute ended up being over an hour.

(: 00:13:28

So all of us, probably just as a whole graduate cohort across the country, probably widened our search for where we were willing to consider. And really because of the flavour of the work I'd done, I didn't really have any strong preference to a clinical population at that point, but I'd only worked, the majority of my work, including training, had been with adults. And so nobody was more surprised than me when I got a CAMS job in basically the heart of Birmingham, but also Sutton Coalfield. And when I was told I have been Sutton, I was like, I've heard of sun, but I dunno where it's so, nobody was more surprised than that than me. But actually I loved it and I made a great CAMS clinician. And what I really, really loved about Cams was just how energetic and joy-filled the team were and how passionate about young people.

(: 00:14:46

And they were just really vibrant people, which might sound really strange, but when I was an aspiring psychologist, and certainly when I was training, it used to be said that if you go to, this is a complete overgeneralization, please don't be triggered by this anybody. But this is just some of the in-house conversations. If you go to a substance abuse conference as a professional, the bar will be rammed. And similarly, if you're working in an adult service, the clinicians might well have some of their own struggles. Whereas working in cams, everyone was just at that point just vibrant and really positive and optimistic in a way that was so refreshing, especially as that was my first qualified job. And it just felt really weird. It felt really weird. I think I've mentioned in the podcast before that I was expecting and sort of hoping for kid gloves that I'd have a period of transitioning to this new qualified role.

(: 00:15:58

But my manager, who I am now good friends with, she was basically like, we've been waiting for you and you're qualified, away you go. And I think that was empowering. So they were thinking of me as qualified, I mean in terms of, I dunno if Kappa still exists, but a choice and partnership approach. That's how the service worked. And it worked beautifully, and it had won awards for patient safety. It was a great service. Great. But in terms of how it works with CAPA is that you don't suddenly get 15 cases given to you. It builds week by week. So that did allow me to have more time to think, to plan, to make sure my notice board next to my desk looked nice, all those things. But it meant that I wasn't suddenly swamped with activities. So I did get to grow into that role, whereas I think still some services might have been tempted to, you are new, have this, and then juggle your new client. That comes in three weeks out four. But that didn't happen. So I was thankful for that, but I was just a qualified member of staff and expected to roll with it.

Thomas Gourley (: 00:17:09

Yeah, obviously being at the stage of my career, I'm kind of focused on the transition onto the doctorate. But yeah, I'm also aware that there, there's been another big transition, and I know a former supervisor of mine talked about that transition in supervision and described it as being where before you're qualified, you don't have ultimate clinical responsibility because you have a supervisor who is responsible for you ultimately. And he said in getting registered after he'd qualified, he'd gone from the Friday having no ultimate clinical responsibility to Monday. Suddenly it's all on him and he's got assistant as well. So yeah, I can imagine that's a difficult transition to make, but you've made that transition and you've gone into your qualified role. So I'm wondering how long were you at that CAMS service for? And I suppose where did the journey into your own practise begin? Both in your mind or your ambition? Was it something that you were planning to do or was it something that just kind of emerged? Yeah, how did that come about?

Dr Marianne Trent (: 00:18:34

Okay, so I was there almost four years, but that did include one little maternity leave and a wedding and all the hen shenanigans that went with that. So yeah, I wasn't planning on doing private work. So before I got my qualified job, I did do some brief project work for organisations, which was basically sort of using my research skills and trying to put together a report for an organisation, which I did really enjoy. But to be honest, the idea of a private work wasn't my own. It was offered to me as an idea by my husband. So I'd had a second, a lot of maternity leave when I was working in an adult service. So I left that CAMS service to come to an adult service. It was closer to home and again, really, really valued my time there, and I learned so much. And that's when I became a trauma specialist, is what I would say.

(: 00:19:55

And I miss my colleagues. I do, I do, I do. So, and I miss my colleagues in Cams as well, but you can keep them as friends once you leave, is what I'd say. So my youngest was starting preschool at the school, and I was only by that stage working three days a week. So after my first maternity leave, I went back to the CAMS service four days a week. And then when I went back from my maternity leave for the adult service, I decided I only wanted to be three because as anybody who works four days will tell you you're basically doing five days work in four, four less pay. So I wanted to absolutely be part-time. And so yeah, it is a bit of a shock when your wages go down, but you have to cut your cloth accordingly is what my parents would've told me.

(: 00:20:54

So I had those two days with my, well being a parent and doing all of the school run bits and pieces for the eldest. But then when the youngest was going to be starting preschool, my husband was like, well, what are you going to do with those three hours a week on a Wednesday and a Thursday? And I was like, did I maybe have a nap? Maybe have a facial tidy the house? And he was like, you could start some private work. And I was like, oh, I, I didn't feel like a proper enough psychologist. I don't think it felt like I needed to be some, I dunno, something different. I didn't feel like I was it, but I was, oh, well yeah, maybe some more money would be nice.

(: 00:21:45

I don't know. So I was part of a psychologist network for private professionals and I'd been part of it probably for a year. So I knew it was possible. And one of my good friends, Cara, I know she worked mind me mentioning she was already working in private and had done for quite some time and she was like, you'd be fabulous at it. Just do it, do it. So to cut a very long story short, I found myself two clinics, one that had space on a Wednesday, one that had space on a Thursday that were travelling distance from my children's school so that I could drop them off for 8 45 and then hot foot it by car to the clinic and then see two clients and then hot foot it back to the school to pick up my youngest just in time. So that was quite an action packed three hours, it really was.

(: 00:22:40

But then the pandemic happened. So I'd started that in September, 2019, and then by the time March came around, obviously it all shifted online and then I didn't have the school run to worry about, so I increased it to three kinds. There was increased demand because of the pandemic, and then randomly ended up setting up an evening clinic one evening a week. So before I knew it, I was ending doing eight sessions a week, and I was so terrified of not getting the tax right that I saved every single penny other than my costs and my overheads for software and I C O, all of the insurance, all of that jazz, because I didn't want to then suddenly not have enough money. So it got to a position where I was like, oh, I'm going to be a higher rate taxpayer before too long. I'm working myself to the bone for actually no benefits. And so it just made me think, well, could I shift the balance slightly? Could I maybe do two days in the N H Ss and then have three days in private practise? And the pandemic was resolving itself, the kids are back at school. And by the time I actually went all in self-employed, it was April, 2021 because my request to drop down had been declined. And it was interesting that sometimes when we might get what we want, we might realise it's not what we want.

(: 00:24:22

It was actually as I was doing my appeal for that, that I suddenly realised if they say yes, I think I might be a bit disappointed, I might be a bit sad. And I think that speaks volumes, doesn't it? Because if you then get what you want and you still don't want it, maybe that's not the course of action you should be taking. So I did then make the decision to go all in, which is not an easy decision. Someone on my cohort had always planned to be a trainee and then set up their own practise, and that is what they did right from the beginning. And to watch that going on as someone that was newly qualified, it was like, oh

Dr Marianne Trent (: 00:25:08

Gosh, that feels like, oh,

Dr Marianne Trent (: 00:25:11

Wild. They had a website and everything. So to kind of go through that process myself, but no, I already could pay my bills if needed. I've got my accountant to help me calculate what I needed as a bare minimum to make my ends meet and still pay my tax and my national insurance and all of that jazz, and to actually take out any passive assets at that time. So by that time, I did have the tricky brain kit and the Grief Collective book and a couple of different bits and pieces, but if we took that out, but it's not as predictable as regular one-to-one client work. So we took that off the table and kind of helped me have a figure for how many clients I needed to see a week. So that's where I started, but it still feels like a big deal. And I would say that I never felt alone.

(: 00:26:08

So people are like, won't you be lonely? But actually my accountant is so lovely, she feels like part of my team. And I've got a virtual assistant, Hannah, who helps me do bits and pieces for socials and keeps me on track and thinking, haven't got any content planned, haven't got any content plan, what are you going to do? And at that time, we were running regular five day challenges for people with complex trauma. And so yeah, I think Hannah and I were doing more work together at that time because there's lots involved in running a challenge. So I never felt by myself, I've never felt lonely. And of course when you're seeing clients, you are connecting with people. And I have done some networking here and there, and I'm part of various groups, but I still talk to Cara most days and other kind of psychologist friends as well. So yeah, that's a very long answer to your question again, but that's what happened.

Thomas Gourley (: 00:27:02

I'm just going to take that you don't feel lonely, but you also mentioned during the camp that you really miss the people you worked with in the services as well. And I know from my own experience, I feel like part of my continuous development has happened in what are informal micro supervisions, just these passing conversations or in my role as an ap, I was really fortunate that we always had two trainees in the team and we had our own room, and they would come in from a session, and quite often there'd be everyone would turn their chairs around and there'd be a little kind of debrief and sharing ideas. We also did a balance group as well every month with the whole team, which would be maybe six of us. So for anyone who doesn't know what a balance group is, it's basic a case discussion that's unprepared. So one person presents a case generally something that they're really stuck with, and that can be either with a client or working with another team or working with a system, but something where they're stuck and the progress of the work has become difficult. They present that for 10 minutes. I don't spell

Dr Marianne Trent (: 00:28:26

That Thomas, I've not heard of that before. Is it B

Thomas Gourley (: 00:28:29

Balance? It's B B A L I N T. I think it's named after a psychologist. So it comes from around the mid-century, I think it was a group of psychologists who created this group in order to have supervision and share ideas and develop their thinking. And it's a really good learning session. I always felt, I think generally I felt Perceptibly developed as a clinician after each one of those sessions. But in terms of just those informal little chats that go on, there's a kind of drip drip effect of development through those. So I'm wondering, when you're saying you missed the services, how do you compensate by working as a loan private clinician? How do you compensate for that?

Dr Marianne Trent (: 00:29:30

Yeah, good question. I'm very perceptive. You, you've noticed what I'd said, and then there being a bit of a disparity there. So it's very tricky because in my CAMS service, I had my own office, and if you're busy, you can shut the door, which is quite clear communication, isn't it? Whereas in my adult service, I didn't even have my own chair. So it was agile working, but in an environment where there wasn't even really room for all the clinicians that were there, but at that point, they weren't that hot on you working from home until the pandemic happened. And then obviously everything became deathly quiet. But I have always, in my qualified capacity and in my assistant and aspiring capacity being a real grafter, I will take on cases, I will fill my caseload. We used to work with a job plan model as part of capa, and that's something that's followed me through my career and I still have now.

(: 00:30:36

So I was recruited to the eight A post in adults to do 50% face-to-face clinical time. And when I started, I was told by another clinician, oh, it's not possible. You can't get the rooms, you just can't see people. I've only seen probably one or two people this year because you can't get the rooms because the rooms were given out to people all across the trust, not just to the people that worked in the building, which again, I think needed me working. So I was like, well, I've been employed to do face-to-face time, I'm going to do it. So I went all over the city getting rooms, so I wasn't always there. So when I saw people, it was a really nice connection time. And actually in my first year of working there, I only was at base on a Tuesday afternoon. That's the only time that I had to connect with people.

(: 00:31:40

So I was used to lots of my time with my colleagues being via WhatsApp or text message or emails. So actually working now in isolation, it doesn't feel hugely different. Does that make sense? So it did. When I went back from my second maternity leave, I have only got two kids. I was careful to give myself more time with my colleagues, and I've always really loved working with aspiring psychologists. So I loved spending time with trainees, I loved spending times with assistants, and I've been able to obviously weave that into my current working model so that I'm still getting that aspect of something that I really enjoyed and that I was good at as well. And of course, I've still got supervisors, so I've got a supervisor for my E M D R work, and I've got a supervisor for my generic practise, not specifically linked to E M D R, and there's a mixture of ages there as well.

(: 00:32:47

So my generic supervisor is a man in the advancing age, and I really love just his view on things and that we do have different personal experiences and professional experiences and what he brings to that. But yeah, so I am still in contact with people and because I've moved more into, I would now call myself a business woman as well as a psychologist. And actually a few years ago that would've made me sick in my mouth because I wasn't comfortable with that idea because I've now moved into those networks. I'm also making contacts in the business world as well. And I'm feeling kind of, yeah, that they're my colleagues as well. So I do do some networking in person, and I do do some networking events, and I'm just freshly back from Galway doing a keynote speech in person. But for me, I like my own company.

(: 00:33:52

I think I'm quite good company. I have excellent choice in activities that I always like to do and I always say yes to. I'm good company and I am all right with silence. And yeah, I like Radio two as company, so I don't mind sound like a really wishy, wishy-washy answer. And solo private practise, working remotely will not work for everybody, but for me it works really well and it helps me to be more available for my children so that they've got mommy picking them up and dropping them off nine times a week. So we are meeting quite early on a Friday. This is the day I don't do it, but it just suits my work life balance and it suits me and it suits my clients and it works for me, but it might not work for everybody.

Thomas Gourley (: 00:34:48

That's really interesting. I mean, you say wishy-washy, but you've actually made me, I was starting to think about the triangle of supervision. So for anybody who's not aware of this, it's kind of a model for supervision on which to structure your thinking around supervision and also supervision sessions. And on that triangle, we have normative, formative and restorative. And these are the three aspects that you might want to think about covering overall during your supervision. Normative obviously being about standardised ways of working, shared ways of working, formative being skills and knowledge. And then restorative being more about you as a person and how things have felt either within the case or just generally. And I think in the answer actually, you managed to kind of go around all three of those points. You talked about supervision and C P D, but also some new skills, so like business skills and keynote speaking, and also the type of person that you are.

(: 00:35:55

So you're happy being by yourself, but you're also happy with the company, but also, yeah, that it works for you on a personal level. So I'm just going to, let's do another quick lap of that triangle as well. So in terms of the normative things, so the standardised ways of working as a private clinician compared to working in the N H Ss, what things do you need that are kind of standardised? So things like insurance, do you need business insurance? Do you need insurance to cover in case something goes wrong with a client that you are responsible for? In terms of, I know that you work online, but what kind of clinic space do you need? How do you get that? How much does it cost? All of those kinds of things. Do you share one with other private clinicians? So yeah, do you just want to do a quick lap of the normative section of that triangle? Sure,

Dr Marianne Trent (: 00:37:05

Absolutely. So it's probably also worth saying that on the morning of my first ever private clinic, I was standing in my kitchen crying because I just didn't feel enough. I would say I was more nervous than my first day working qualified, more nervous. I don't remember being nervous when I was starting training, I didn't have time. I just got back from India as well. More nervous than my first assistant job. I think it's more nervous, probably as nervous. It was on my viver day really. I just felt awful. And the idea of asking someone for money for what I did, that felt like common sense. I think that's the thing we get so schooled into what we're doing that the idea of actually being paid more than 22 pounds an hour or whatever it was that we were on at the time, it felt like I was robbing a bank.

(: 00:37:58

It felt like I was doing something really, really naughty, but actually, and I felt like I needed to be able to give extra, do more to earn that money because I was so institutionalised by being an employee. I would say that certainly initially the work was easier than the N H S work I'd been doing. And very quickly I was like, oh, it's fine. It's all, so yeah, you do need to register with the information commissioner's office, the I C O, I mentioned those earlier, but I didn't give you the full details about what I C O was. And you need to have processes set up for your G D P R, how you're going to keep notes, all of that jazz. Mine's all electronic and you need to have in insurance.

Thomas Gourley (: 00:38:49

Sorry, does that mean, does that you, so in the N H Ss, we are ardent note takers and we can be audited, and in fact, patients can access their own records and their progress notes. It's information that is kind of rightfully theirs. So I'm assuming that means that that's the same working privately, but there's a slightly different process in which you have to hold that data but also make it auditable. Is it auditable by the H C P C?

Dr Marianne Trent (: 00:39:22

So yes, the H C P C at any time could contact you and tell you that you've been selected for audit. The clinical platform I use makes it all quite easy to download and share notes if and when required. And of course, so clients still like they can in the N H S request access to their notes, but largely speaking, they don't tend to, unless it's some legal funded work or something. But yeah, it's still absolutely the process and you do need to have indemnity insurance. But actually I would suggest to anyone listening to this, perhaps even when working at trainee level, perhaps even before that to consider insurance anyway, it's not a fortune. It's probably 150 pounds a year for a level that's reasonable cover. Because I would say that the N H S will cover you in an unlimited capacity, I believe, but only if you followed the right procedures and processes.

(: 00:40:23

So if it's found that you haven't, you're going to be liable, which I don't think they don't always tell you. So if you had your own, you're about to be a little bit sick, Thomas. If you have your own cover, then you are covered regardless, and it just feels like a little bit of immunity. So yeah, I would say for anyone listening to this, if you're working in a clinical setting to consider getting your own indemnity insurance, and there's a variety of providers, I use oxygen as towergate. There's a few others as well, but I think they're all standardised pricing, a bit of a price fixed situation, but just something to make you feel a little bit more confident because we are the best one in the world. Sometimes you may not do clinical notes within 48 hours or whatever it is that your trust wants, which then would not be you following procedures.

(: 00:41:18

So it might be potentially something as small as that that might lead you to standing on a stand in speaking to Your Honour, and all of us have been there. All of us have been there where we haven't met the targets. We haven't perhaps done what we should have done. If you've maybe let your, what's it called, that training that you have to do mandatory training, it gives a bit of that lapse. Then technically you're not compliant with the trust regulations and requirements. So yeah, I would look at some sort of indemnity cover wherever you are. Initially, I was doing all of my private work in the clinic settings and the prices for that will absolutely vary depending on which part of the country you are in. I was paying 25 pounds for the two hours that I needed, so technically I could have wanged in an extra client if I'd had the space, if I'd had the time and no time limits because they tend to do it in half days.

(: 00:42:19

So people don't often want you to do ad hoc hours here and there. They will want to look for something a bit bigger and more consistent. But that said, even on Harley Street, I've seen that you can get therapy rooms for as little as like 12, 13 pounds an hour. So please don't be daunted by anyone that you see talking about themselves as a Harley Street therapist because it doesn't mean what you think it might mean. So yeah, there's quite a few steps and stages to overcome initially, but actually it's just that all of those steps and stages have been done for you if you've been employed before and now you're responsible for it yourself. But yes, it's not, it doesn't need to be as daunting as you think it might be. And connecting with other professionals who've been through that can be really useful too. It might be worth saying, I've also got a webinar, a masterclass on considering going all in self-employed. So if anyone's interested in checking that out, they can check out the details in the show notes.

Thomas Gourley (: 00:43:23

How about, so that's the normative way. And I suppose within that, actually, there seem to be some new skills as well that are unique therefore to working privately, like organising these things, a lot of admin, but also learning about the potential limits of indemnity insurance when it comes to working for a big organisation, which I for one didn't know. So thanks for that pro tip. I'm going to look into that. That's not to say that I don't always work within a protocol. I try to, but sometimes, yeah, maybe I'm not even aware in the moment whether I'm or whether I'm not.

Dr Marianne Trent (: 00:44:05

For example, if you suddenly went home sick and you just weren't well enough, you might easily forget to do your clinical notes or not do them for a week or so, and that's just part of being human. But technically it might be that if something happened to that client and the team weren't aware that we fall and foul of the trust procedures there, and they might be like, well, we told you to do clinical notes within 48 hours. It's a small example, but one to be aware of, I think for sure.

Thomas Gourley (: 00:44:37

Yeah. You touched briefly on working privately as it working for you on a personal level, but without wanting to ask about your personal life, but I would like to know what kind of person do you think would succeed in private practise or in blenders, maybe part-time, N H Ss part-time practise or even full-time private, is the type of person who is maybe more geared towards succeeding in that setting?

Dr Marianne Trent (: 00:45:20

I would say no, absolutely. And the question might be, are you more driven by money than any other clinician? That might be part of the question. And I guess when we look at our own stories and our own relationship with money, there can be money, trauma. So growing up at different times, there's been money in my family and no money in my family. There's been times where my parents were having to shop in Netto and only buy Tesco value food. That's kind of the era that I grew up in where you had to go to school with blue and white striped crisps, which was the worst thing imaginable. It was like, oh, value, value. And I guess the worst thing is no crisps at all, isn't it? Because then you can't afford crisps at all. But yeah, there's been times when there's been more money and less money, but my mum's always, her mantra has always been, look after the pennies and the pounds look after themselves.

(: 00:46:25

And if we were ever going out for lunch, if I didn't choose egg sandwich, I'd be like, I was made out to be a millionaire, because egg is traditionally the cheapest in any sandwich in any shop, so cheap. So yeah, I was always taught to be quite frugal, and the earning money is good. Yeah, I do like earning money. I've always earned money. Even when I was 13, I was working selling magazines that were called Candice, I think they are still around. I wrote for it recently. Then my brother broke his leg and I ended up doing his paper round, and then I ended up working washing up in a hotel, and then I worked for Boots. And so I was always used to working and enjoying that and feeling like I got a sense of satisfaction from having my own money, but then growing up in a family where my mom had always worked and had her own money as well.

(: 00:47:21

So that is just the way that for me grew up as normal, that you have your own bank account, you can do what you want to do. You might also have a joint account when you are married as well, but being able to look after myself and be independent, have my own car, and so I needed to be able to earn enough to do. I've got a 10 year old car, Thomas I, I'm not extravagant as a person. This necklace came from a charity shop. I'm not extravagant, but I want to be able to afford the things I want to be able to afford. And yeah, I don't work as many hours as you might assume, so you might be like, oh, well, she's in private practise, probably. She sees as many clients as she did in the N H s. She's probably a higher rate taxpayer.

(: 00:48:12

She's probably absolutely milking it, especially with everything else she's got going on. I'm not a higher rate taxpayer as yet. I only want to see nine clients a week, three mornings a week, because otherwise I will be depleted. I won't be as good for those clients. If I was seeing 20 a week, I wouldn't have enough in the tank. So I balance myself. I go to personal training twice a week, which again, I know is quite extravagant, but I pay 25 pounds a session and it does so much for me. So I'd go on a Wednesday lunchtime and a Friday morning because that helps me build exercise into my week, into my work week rather than trying to tack it on. And again, I know that's a luxury not available to everybody, but yeah, do you need to be a particular type of person? You need to be able to give yourself permission to earn money and to do that transaction between yourself and a client.

(: 00:49:23

And if you are working in a face-to-face setting, there might be reception that can handle that for you if you don't want to do that. Not all clinicians want to handle the money or do the contracting and all of that jazz. My contracting is largely done remotely. It's done via the platform. So you explain your terms and conditions, but then you send them and they're all sort of sorted out that way, but you have to give yourself permission to earn money. Some people do set themselves up as c I C community interest companies if they want to do that, but I'm okay with making a profit and charging for my time. And even with the Aspiring Psychologist podcast, I do have these free resources. I do have the free q and As, but if people have the resources and have the will, there's other ways of working with me as well, which are not free.

(: 00:50:14

They're great value, I still think, but I know some people are a bit like charging money for that, but it takes me hours and hours and hours and hours and hours even to do podcast episodes, even to edit them, even to schedule everything. It costs me money to do all of this. Even the platform we're streaming on and the platform that the podcast is then hosted on, it's not free. And the stuff with the membership, again, that's not free. I pay all of my experts within that. So I know, and even people saying, oh, you've taken the N H S training and now you're not even working for them. For some people that feels like something they don't want to do or can't allow themselves to do. But I feel like I've been exceptional value for the N H S and that I still, in essence, do some N H Ss work in helping support aspiring psychologists and supporting the wellbeing of the country when I do different bits and pieces as well. So you have to be able to give yourself permission to earn money in a way that might look different than it was if you were salaried. I've not always been this out there with the stuff that I do that's come with time.

(: 00:51:33

What you very quickly learn is that people aren't necessarily going to come flooding to you, knocking on your door, wanting to ask to give you money. You have to be okay with putting yourself out there and discussing the things that you have that are available for people to spend money on. And that is a transition period. Even my mom on my social, she's like, oh, you like talking about yourself, don't you? I'm a business woman. You have to do that. And that's a comfortability curve, I would say. And that will just come with time. And if you want to funnel more money into paid for advertising with different platforms to get your one-to-one clients, that's a possibility. I don't struggle for one-to-one clients. They're always fairly consistently available at the level that I want. So I advertise on Psychology Today, which keeps things kind of trickling in. But I think, I don't know. I don't actually ask my clients where they hear about me from. I perhaps should start to, yeah, I feel like all my answers to your questions are very rambling time.

Thomas Gourley (: 00:52:46

No, no, no, not at all. And in fact, that's kind of covered a lot of what I was going to ask about next in terms of maybe the pros and cons between working privately or working for the N H s and yeah, one of those things is the financial implications. So on the face of it, I mean, I'm sure most listeners have had a look at private psychologists websites and seen that their fees, and they seem to be, depending on whereabouts in the country they are, I'm going to exclude London somewhere between 80 and hundred 50 pounds an hour. We all know we're not getting paid that at Band seven. But of course, there are cost implications as well. There's no pension either, which is renowned in the N H Ss cost, like insurance costs, like clinic hire. So I suppose just very quickly, do those costs and earnings balance out to make it worthwhile.

Dr Marianne Trent (: 00:54:02

It's probably worth saying that until about four months ago, even with me working what I consider in a really diverse way and really hard, I was still only paying myself what I got from the N H S for working three days a week.

Thomas Gourley (: 00:54:21

Okay. So do you have moments where you think I could, it would be nice just to rock up eight till four a service, do my work, and then just go home?

Dr Marianne Trent (: 00:54:35

No, not anymore. I think I'd got myself to a position where I was unemployable because I would know, I would say no. It got to a position where I was probably verging on being unemployable. I was so energised for everything that I had going on and learning about how to serve clients better and how to do it quicker with less of the loopholes that were involved, which was the things I found really frustrating about employed life and just thinking about, I know learning about funnels and things like that for how to get clients on board for working with me and stuff. I was going private at the point where there was a platform called Clubhouse, I think it is still around, but it's not around as much. And it was launched at a time that allowed it to just go wild. So it was launched at a time just in the pandemic when everyone was home, everyone was stuck.

(: 00:55:47

People were just really receptive to be able to listen to this kind of live streaming of business experts basically. And I just lapped all that up. I was really, really energised by that. So it got to the position where when I was at work, I wanted to be working on my socials or doing X, Y, and Z or writing a book. And I wasn't, of course I wasn't. That would be really unfair, but it got to the stage where I felt like I was having an affair that I would rather be somewhere else. And so that really helped to make my decision. I just think now I'm so used to doing what I want to do when I want to do it. I would find employed life quite constraining.

Thomas Gourley (: 00:56:38

Okay. We've talked a lot about working privately from the perspective of the psychologist and how the journey goes into it and the various pros and cons, the various different ways of working and things that you need to consider and maybe the things you need to be and embody. But I really want to give a bit of time and a bit of space to the clients as well and ask you about your thoughts on what the private sector can uniquely offer clients, what does, because I'm aware that there could become a kind of us versus them in terms of N H S versus private, but they both exist for a reason, and they do both offer perhaps unique things that the other way can't offer or ways of working that can't be done. So yeah, what do you think the private sector generally for psychology can uniquely offer clients and why?

Dr Marianne Trent (: 00:57:52

Yeah. Okay. Good question. So I would say the primary and possibly even one of the only benefits is there might be zero weights. And I know that we speak to each other as of yesterday when record N H Ss weights, certainly for physical health, were announced as up to two years. And that's not uncommon in mental health services as well. So currently, usually if someone emails me, they can usually be seen at least for an initial assessment, if not necessarily a regular weekly slot, but certainly fortnightly to go weekly if they want to within a couple of weeks. And that's often just not heard of in N H S services currently. I wish it was, and that was something that I was absolutely trying to sort out. So when I was going on my second maternity leave, I got the weights from the service down from two and a half years to six months because of the way I was working of that, that I was offering 50%.

(: 00:58:58

And fortunately, by the time I got back to the service, it had gone up again. And we never quite recovered from that, perhaps because I was working three days a week rather than four. But that for me is an advantage. But in terms of the level of expertise available in the N H Ss and the level of passion and care and commitment, I would say that is second to none. People in the N H S that I've worked with care so deeply about the clients they work with. On the whole, I think I was doing the majority of the assessments in the service I was most recently working at, I was holding the client's stories in my head. They weren't just names, they were people. And that was difficult because having to say goodbye to people, I'd never get to meet in my head, I'd assess them and they were never going to come to the top of the waiting list.

(: 00:59:52

Whereas often when I'd meet people, they'd be like, oh, I hope I get to work with you. And often they did because I saw lots and lots of people. So letting that service go and letting those clients go, but letting those really professional established clinicians out of my day-to-day radar and the cross-professional working that you work with, that's unique, isn't it? Even the informal conversations you are able to have in an employee capacity that then have a cost attached for the client if they want that outside of that. But often people have got practises that have got even private. We've got multidiscipline approaches, but I've got people that I can work with informally and ad hoc here and there. But in terms of the full M D T meeting and the case discussion and stuff, clients aren't necessarily going to get that. But often type of clients we're working with don't need that anyway.

(: 01:00:53

And one of the other key benefits other than waiting times is session number. So sometimes I'm working with a client and I'll actually say to them, if we were working in the N H Ss, you wouldn't meet the criteria for this service. And so it's a lower level of intervention, but they want it from a specialist rather than someone that could actually probably do some of the work in a more junior capacity. And they want to know that they've got that for as long as they need to, and that if they want to, they can dip back in a month if they want to, they can check back in six months. Do you see what I mean? So they've got more freedom, they've got more control, but private work is not always self-funded. Private work might be legal funded. It might be. Some of my favourite clients to work with are actually those that are covered by their own occupational health cover plans, and that feels a bit more like N H SS type working actually. So even though those contracts are less lucrative, I do enjoy the work for the type of clients that I pick up from there.

Thomas Gourley (: 01:01:58

Yeah, that's really interesting. In terms of the M D T working that you can still access that, given that you say not many of your clients require that, but it's useful to know, I think, because one of the images of my mind being in a clinic with multiple different teams to going to working in a garden shed, it does seem like suddenly you're really on your own. And so it's good to know that that can still be a transferable. What do you think things,

Dr Marianne Trent (: 01:02:38

Just to speak to the point where you are working with less complex clients. So what I know in N H S services is often you are working with clients sometimes who really need to be in an inpatient setting, really not well, they're not thriving, whereas I wouldn't necessarily work with clients at that level of crisis in private practise that would feel unsafe. That would feel risky for me and for the client. So I think I'm working with complex but not actively in crisis clients, if that makes sense.

Thomas Gourley (: 01:03:14

Yeah, absolutely. And it sounds also what you're saying about the amount of sessions and yeah, I'm aware in the N H Ss, there's generally a commission to do a certain amount of sessions, especially when it comes to things like C B T, and that of course is evidence-based limit on sessions that I think it's within six sessions you get your most effects and then it kind of plateaus. So I suppose in terms of commissioning and resource, if the evidence says that 12 or more sessions you just plateau, then you shouldn't really be commissioning more than 12 sessions. But what it does do, I suppose, in the private setting is give clients the control over how much they want. Obviously not withstanding the fact that that is a collaborative conversation about whether they need it as well, but it certainly seems a bit more control and discussion around that, which is good.

(: 01:04:14

I also wonder about population groups as well, who might not access mainstream services in the N H Ss. Not that they can't, but wouldn't. One of the things that I'm particularly interested in is elite football. We don't have time to go into that, but there are many clinical presentations going on and some clinical issues in elite football, but you wouldn't necessarily see an England footballer sat in an N H S waiting room. So people who live and work in a world which is very structured like elite football or the military might not find their way to an N H S mainstream service. So there's perhaps potential population groups with whom the private sector can uniquely work. But one of the things that I wanted to ask about is evidence-based practise versus innovation. So generally speaking, in the private sector of the arguments for its success, is that it's kind of less regulated.

(: 01:05:26

So it's more open to be able to innovate and to try new things that are maybe not tested or proven or have a huge or decades long evidence base. And I sometimes see that with people on LinkedIn who might post about something they're doing, a model that they're using. I've never heard of it. I look it up, the evidence base is slim or completely absent. And I take very seriously the model of being a scientist practitioner. And so far I might change my mind, but I take that as an obligation. And I think if I'm not being a scientist practitioner, I'm not being a clinical psychologist. But on the flip side of that, is there an opportunity to try something which although hasn't been proven, might have some evidence, but whereas it might not be commissioned by the N H Ss for that reason, there's an opportunity there in the private sector to innovate and use new models and new ideas. What do you think about that?

Dr Marianne Trent (: 01:06:32

Yeah, I think there probably is. It's not really something that I have done. I'd say I'm still a very similar clinician now than I was when I was employed. But there are people, for example, someone had on the podcast recently who were doing sort of ecotherapy and stuff outside the therapy room. And that's a really nice opportunity to bring something of yourself, but also stuff that's got an emerging evidence space. But I think it gives you freedom and permission to be yourself and to niche as well. So you only have to work with the clients and the populations that you want to. So I only work with over seventeens, really over eighteens. Ideally for me working online only doesn't feel safe enough for working with children and young people. So I've now not working with any children's or family services, which feels different because I did really love that years ago.

(: 01:07:32

But I now feel that I do feel equally as competent in working with children and adults because of the length of time I've done both. But I would say I'm now a specialist, adult clinician, and I kind of will see trauma, complex trauma, complex grief, and I will do O C D because it's usually linked with complex trauma. But I wouldn't necessarily see myself as a specialist O C D clinician. But if there's complex trauma roots, then that often is something that I will do. But I can say no to other bits and pieces that I don't think I'm the best clinician for. Whereas when you are in a team, you can't always do that.

Thomas Gourley (: 01:08:27

Yeah, absolutely. I think for my limited time already, I can see that there are particular types of work that I would prefer not to do if I could choose and that I'd rather put my energy into things that, I guess the path of least resistance, a type of client, a type of issue, a type of wave working that just feels really good to me. So yeah,

Dr Marianne Trent (: 01:08:59

Like I could

Thomas Gourley (: 01:08:59

Do that,

Dr Marianne Trent (: 01:09:00

But it will take me a lot more and I'll need to do lots of reading around that to do that. Or I could do what I'm already in my zone of genius in, as they say in business terms, where actually things will come more freely to me and I will be more help to you as a clinician because I'm having to do less learning and scrambling and getting to where you need me to be. When you're working with me in complex trauma, you want me to say, oh, actually this is a really good example of that and I wonder if this is happening. Not me going, oh, right, how do we work with pain again? What's that approach? What's that thing? Oh, I dunno what I'm doing there. I wouldn't ever say, I say to a client, I don't think I'm the best choice for you.

(: 01:09:52

This has turned out a bit different than we expected. And they might still say, I still want to work with you. I like you best. And it's like, well, you can make that informed choice, but I'm still regularly telling you this is largely pain work. I'm not much good at pain work and they're still making that choice to work with me. That's their choice. But I wouldn't generally go ahead picking up pain clients because I don't know, I'm rubbish with pain personally. I don't necessarily mean rubbish clinically, but really difficult. And that said, if anyone's watching painkiller on Netflix at the moment, I've just finished it yesterday with my husband. It's really, really interesting. And yeah, useful watches and aspiring or qualified psychologist.

Thomas Gourley (: 01:10:35

Thanks. I'm just aware of the time that maybe it's slightly longer chat than you usually have, so I think maybe we should think about moving to the end. So I'm just going to ask you your general thoughts and views around the future. Maybe general reflection if you want to on the future of clinical psychology in the private sector and the N H Ss, if you want to get politicised about that, you can, but maybe more specifically the future of yourself and it can be a long career. And yeah, just tell us about what you see in the future for both of those things.

Dr Marianne Trent (: 01:11:27

Yeah, I mean I can't ever really imagine not doing psychology, so I can't imagine retiring and not being a psychologist. And I know that's not unusual as a profession because I feel like it's part of my identity. I love being a psychologist. I love being Dr. Marianne Trent. Actually, it feels weird that I just wouldn't do that and that I wouldn't continue to earn money in some capacity because the state pension's not going to be enough. And I left the N H S too early to have a really well, and I'm the wrong age to have a really nice N H S pension and I have got a private pension. Well, I probably started that too late. So I think many of us are going to need some sort of supplementary income. I don't own any properties to rent out or anything. That's not something we've gone down the route of.

(: 01:12:31

But it is interesting because what quickly became apparent when I first qualified is that the N H SS training scheme is not a guarantee of employment and ordinarily there's jobs available, but what we learned in 2011 is there's no guarantee of any N H SS employment. It doesn't lead to a Band seven or preceptorship role. There's not funding earmarked for paid qualified work just because you've been trained as a qualified psychologist. And so I could potentially have moved into private work at that point. But really I feel what is useful about band seven's roles is that you are able to come up to full speed of being qualified, which really full speed is eight a. I would say that's traditionally how they were thought about two years of band seven and then preceptorship to eight A. And certainly in my experience, that's absolutely the case. I've become a better and better clinician the longer and longer I've been qualified. But in terms of the future of clinical psychology, it's really tricky. I think some element of AI will come in and that will be sad for the profession and sad for the clients as well because connection with another human and being able to share things that you feel have deeply personal and private with someone where it feels safe and trusted to do that. Honestly, it's just the biggest privilege.

(: 01:14:15

I don't know if the funded n h s route will continue in this regard for the foreseeable. If we think about will this still be like this in 10 years, how is it possible that counselling psychologists who largely are similarly qualified and experienced to ourselves are having to self-fund and forensics as well? How is that, okay? How has that been that there's only funding for educational and clinical that feels massively unjust? So will it be that it will be levelled across the board or will it be that it will become self-funding, starting to see more courses signing up to self-funding routes over the last couple of years? I don't know. I still feel like I've got the best job in the world that it allows me to do clinical work. It allows me to do, I've got TV series starting on Sunday. It allows me to write for the media in the Galway. It allows me to stand on stage in Galway and talk to people who are equally passionate about mental health and the career of psychology. And that is all because I did a psychology undergraduate degree. That's what my key stakeholder benefit was to begin with. That's allowed me to jump through all the hoops to get where I am, to be sitting with you discussing my private career. Why would you not want to do this job? But will it always exist like this? I don't know is the answer.

Thomas Gourley (: 01:15:52

Yeah, I suppose those are big elements, aren't they? The future of the N H Ss, which could go in one of two extreme directions has kind of ebbed and flowed the whole time that it's existed and continues to ebb and flow. And yeah, the AI is coming over the hill real quick. But yeah, I'm also interested by the AI idea as well. Wait to see what impact that has and yeah, actually really have no idea. I guess that's probably about as much as we should talk about. We've covered your journey out of D clin into N H s, out of N H Ss into a kind of blended situation, then into full-time, covered some pros and cons, normative formative, restorative, some big reflections as well in there. So I think we've covered just about everything that we could. So that's been really interesting. I found it really interesting.

(: 01:16:58

So hopefully everyone listening has found it really interesting as well. So thanks for tuning in and listening, and thank you for having me, the informal host for the day. It's been really fun. Also, as a final note, we should mention that Marianne has her free compassionate q and a that you can access information about across all of her socials, which is Dr. Marianne Trent. There are two sessions coming up. So the first one is Tuesday the 3rd of October at 6:00 PM and the second one is Tuesday the 7th of November, also at 6:00 PM So check out Marianne's socials if you are interested in joining any of those, which I think just wrap wraps everything up for today, doesn't it? So I just thank my guests, Dr. Marianne, Marianne Vent, who is also obviously the lead leader of this podcast, and thank the listeners for tuning, tuning in and having to listen to this reversal and finding out a bit more about Marianne Marion's Journey's journey herself at to this point, this point. Thanks Marianne. How you,

Dr Marianne Trent (: 01:18:17

Tom, thank you so much and for your bravery in tackling me and suggesting this podcast episode. If anyone else has got any ideas for podcast episodes, please do feel free to let me know. Or if anyone wants Thomas to grill me on anything else, let me know and I'm sure we can sort that out as well. But you are about to start your journey as a trainee. In fact, by the time this comes out, you will be in your teaching block. So I hope it goes so well for you. Thank you again for your time, Thomas, and thank you to our listeners for listening.

Jingle Guy (: 01:18:55

If you're psychology with this podcast, you'll be on your to being qualified, the psychologist

(: 01:19:16

With

Jingle Guy (: 01:19:16

Dr.