Working psychologically with serious and catastrophic injury

Dr Marianne Trent (: 00:00

What is the role for psychology in catastrophic injury cases and what is case management and how can that play out as a psychologist? That is what we are going to be exploring in today's episode as we meet a qualified clinical psychologist who specialises in all of this. There's so much to learn about compassion, dignity, respect, and doing a job well. I hope you'll find this so useful.

(: 00:31

Welcome along to the Aspiring Psychologist Podcast. I am Dr. Marianne Trent, and I am a qualified clinical psychologist. One of my favourite things about psychology is just how people can take essentially the same qualification and turn it into something completely new and unique from what another qualified professional might be doing. That is exactly what is going to be happening today. We're going to be meeting someone with the same professional qualification as me, which is clinical psychologist, and we're going to be seeing about the work that she does and how she does it and why it lights her up. I hope you find it so useful and I'll look forward to catching you on the other side. Hi Shabnam, welcome along to the podcast.

Dr Shabnam Berry-Khan (: 01:20

Oh, thank you for having me. It's exciting to be here.

Dr Marianne Trent (: 01:24

So you are a qualified clinical psychologist, aren't you?

Dr Shabnam Berry-Khan (: 01:29

I am, yes. So I qualified in 2008, which makes me feel incredibly old, but I like to think of myself as wise in experience now, so yes, yes, I've been qualified for a little while.

Dr Marianne Trent (: 01:43

Brilliant. Could you tell us a little bit about your journey to psychology?

Dr Shabnam Berry-Khan (: 01:49

So I recognise that psychology was something you can actually make a job out of. When I was at school aspiring to be a medical student actually and to be a doctor, that was kind of my ambition at the time and I realised quite soon into a level that I'm not going to get there. I'm not a straight A student and also I really don't understand chemistry and biology like I probably should if I'm going to be a medic. And then I started thinking about, and I didn't realise this is the first for a, I suppose, into understanding values and the importance of values. Started thinking about what do I actually like doing? What interests me, what gets me going? I came to a bit of a dead end until at school someone came and spoke to me, spoke to the school about sort in a motivational interviewing kind of way, sort of motivational speaker. And I just thought, wow, to use words so powerfully to change how people feel is an incredible position to be in and how you can use that for good and I don't need anything, I just need my words. And so that's kind of where the psychology came from. The idea of doing psychology. So my first introduction into psychology was actually at university and that's where I learned about clinical psychology and my journey to clinical psychology was actually via a PhD.

(: 03:26

And then I became got into clinical psychology training and here I am doing two different things but using very much psychology skills nonetheless.

Dr Marianne Trent (: 03:37

Thank you for that whistle stop tour. So you are Dr. Dr. Shabnam Berry-Khan?

Dr Shabnam Berry-Khan (: 03:42

I am, it seems, or Dr. Square as my friend calls me sometimes.

Dr Marianne Trent (: 03:47

Oh, amazing. Which as well, you must have been a really good support to your cohort as well in terms of your academic rigour and your research skills too. I know that I would've loved to have had somebody in that regard on our cohort too.

Dr Shabnam Berry-Khan (: 04:05

Yeah, it is a really good set of skills to have. I don't necessarily think you need to do A PHD to have develop an interest and a passion for research, but I think that has carried through certainly that sort of background for sure. So yeah, it's a good set of skills for sure.

Dr Marianne Trent (: 04:24

It certainly is. Right. So let's have a think then without obviously giving away any client case studies that wouldn't be appropriate. But could you give us a couple of examples about what serious and catastrophic injury looks like? Because the area that you are working in at the moment?

Dr Shabnam Berry-Khan (: 04:45

Yes, that's right. So I work both as a treating psychologist in the serious and catastrophic injury field and a case manager in the same field. So it's sort of two ways into the same client group, but in terms of if I can give you a picture of the kind of work that we do do and then hopefully that'll bring a sort of helpful case study to mind. So the work is very systemic ultimately. So when we're thinking either about case management or treating psychology, you are working with people who have suffered a life changing injury. So that means that they are not living the life they would've had had it not been for the injury. And therefore in order to rehabilitate or to try and achieve their life goals, which they should absolutely be supported to try and achieve, there's an awful lot of systemic input that needs to go in.

(: 05:46

So I'm talking about therapies of course care in my field because they are seriously and catastrophically injured, often liable to someone else's mistake, there is a whole legal machine going on around them. So there are a lot of people involved in trying to get someone to live the life they should have been living. And so as a case manager, you are managing that entire package and there's a lot of formulation work that goes into pulling all of that together. As you can imagine, anyone who's trained or interested in systemic working, there's a lot of interpersonal dynamic features that you draw upon and kind of pulling that story together, having a narrative that everyone's working towards is super important in my opinion. And as a treating psychologist, you are then one of the team members. So you would be the treating psychologist, supporting again, usually the system as opposed to specifically the client, although there are obviously occasions where you are supporting the client themselves if they have the capacity and the goals and the outcomes are related to specific work that they are that we're working on together.

(: 07:13

So I guess I'm thinking if we work, and we do work across the lifespan as well, but as you imagine the systemic focus is different when you're working with paediatric clients, there is a lot of interagency working schools, any community type input, statutory services of course, obviously you've got the family who are in a very different position working with the child clients than the family working when we're working with an adult client. So there's already, I hope that picture suggests that your lens is quite broad while you have the potential depth to work with a client who perhaps is struggling with the injury that's happened to them, that may not always be the case. So the work that you do is often very systemic and very trauma and needing to be trauma informed as well.

(: 08:19

In terms of a case specifically, a good example perhaps of a case could be a particular client. So it is a case managed case that I work with and one of our treating psychologists is the psychologist on the team as well. And the referral for psychology came through because the client was exhibiting behaviours a challenge, but in order to understand how to think about the function of that behaviour and the communications around it, there was a lot of interdisciplinary working with the speech and language therapist for example. There was communications with the care team through that discovery, through those interactions, we worked out that the care team actually didn't have a lot of brain injury experience and this client unfortunately did have a brain injury as a result of the accident that happened. And what was happening was that the staff retention was very poor as a result.

(: 09:36

And so the psychologist and me as the case manager, we were working in unison to try and understand how to create a stable team before we can even think about what the behaviours are about specifically because the system wasn't quite right. We had to get mom and dad on board with that. And so there was lots of joint working and lots of thinking around how they were relating to what had happened to their family member. We also had to check in a lot a number of times with capacity. So the client, as I'm sure a lot of your audience will know that capacity is time specific and decision specific. So we had to really bring that into how we were thinking around the client's needs, linking in obviously with the legal team who wanted to understand what we were doing and why we were doing it, as well as thinking with the rest of the sort of therapy team so they understood how we were making sense of the behaviours, but needing to do this sort of preemptive piece around stabilising the system in which the client was operating.

(: 10:50

It got really complicated at one point, but between the psychologist having a really strong formulation that everyone bought into and from which there was a shared understanding of what the goals are that were based on what the client was wanting, we were able to, while we still are navigating through how to work in unison and with the client rather than to the client. And so it's been a really long piece of work. I think that one of the biggest differences of working in our field is that there's a lot more liaison, particularly with the legal teams because they're the ones who are collating all of this data that you are otherwise generating and having to justify it either from a cost perspective or in terms of, well, usually in a cost perspective, but in terms of clinical advantage, why would you spend that time thinking about stabilising the care team? And so you end up being quite analytical in a different way perhaps if you were working purely clinically with a client. Does that make sense?

Dr Marianne Trent (: 11:58

Yeah, it does. It's a very big job, isn't it? And one with many different plates spinning simultaneously I think. But I think what we're talking about here is big accidents at work, big accidents in education settings, basically anything that's not your fault, that might be like a serious acquired brain injury or maybe even someone having to be a wheelchair user for life or both. That's kind of the level where we're talking about here. Is it Shana?

Dr Shabnam Berry-Khan (: 12:31

Absolutely. Often our clients are injured as a result of medical negligence, so we get a lot of birth injuries, for example, or clinical negligence procedure going wrong and leaving someone either as you say with spinal cord injury, orthopaedic injuries or a brain injury is big sadly. Or it could be a road traffic accident. That's our usual sort of incident sort of categories. You could say you're right, things happen at work, things happen in other localities as well. Settings. So injuries can happen anywhere. It's more prolific I think, than we perhaps might otherwise imagine.

Dr Marianne Trent (: 13:20

Yeah, thank you. And how do you keep so positive and hopeful for what might sometimes feel like a really, really emotive challenging role that you are doing?

Dr Shabnam Berry-Khan (: 13:35

I think, I suppose it comes back to that values piece right at the beginning, really knowing what interests me and how I can make that operational in my life. And it's taken me a really long time to get there. I didn't quite realise I was actually on the right lines way back when. And then you get distracted, don't you? And then suddenly you are in that place of needing where it matters because actually the clashes and the conflicts become more apparent the more you live life I suppose. And then other priorities kick in family and just wanting to be me turns out that that's quite important and I need to build time in. So I think there's several transitions that happened. So it's not just the mindset side of things, it was also where I was working and how I wanted to work and where would I get that best work-life balance.

(: 14:35

And I think for me, I realised there was a gap in the market, so to speak, with in terms of psychology supporting these catastrophically injured clients and thinking why is there a gap in the market? This is outrageous, but I was working as a case manager at the time, so it was my way in, but I kind of smelt what sold, so to speak, to use an Alan Sugar term. And it was quite clear that this service was not available either in the NHS in that long-term way and it wasn't otherwise seemingly obviously available in the private sector. And so that positivity comes from I think wanting good things for our clients, but in the process of that and giving things to our clients that they need and the systems around them, but also being able to have something that's reasonable for me as well to be able to stay myself in. But I dunno, am I really answering your question?

Dr Marianne Trent (: 15:39

I dunno. Yeah, no, absolutely you are. And I think you are also illuminating some people say if you can't see it, you can't be it, but you are actually are saying, well I can see, I can't see it so I can be it. And you've kind of given yourself permission to go out there and create that unique service for that niche that was already there that nobody really noticed was there.

Dr Shabnam Berry-Khan (: 16:02

Yeah, I think, yeah, it was absolutely. And I think when you are in touch with that passion and when you are in touch with that desire to help, which is obviously why we do what we do, ultimately, I think it was obviously a bit easier because I sort of fell into the case management world and then realise, gosh, there's this area that I can really help with. And I suppose it took courage to be able to do that as well. And it's really challenged me in terms of thinking outside of what I've been trained to do and thinking, oh, I've got to think about other things like KPIs and how can I create something that also doesn't lose me in it, but how do I get others to, how can I use the resources that are out there in the world to be able to help? So where I didn't think I was a creative person, I'm actually creative in this way, I think don't give me any drawing material, I will not draw anything for you that resembles anything that I say I'm drawing. But the creative element in me comes out I think here when we're talking about how to create something to offer people that they wouldn't otherwise get perhaps. And yeah, that's massively motivating for me.

Dr Marianne Trent (: 17:29

Oh absolutely. Yeah. And I also don't think I'm particularly creative, but there are many, many things that I do create. And for listeners of the podcast, they will have probably maybe already listened to an episode, which as we record is coming out imminently but isn't currently available right now. But it's with Juliet, Dr. Juliet, who is creative clinical psychologist over on Instagram and she's wonderfully creative. I dunno if you've seen her drawings, but they're so good. They're so good. You should check them out. I'll send you a link. She's so good. And the way that she kind of depicts clients' experiences, so she's currently working with services with children and asylum seekers and the way that she kind of weaves that into her work, but she also makes the work available for people to be able to use with their clients as well. But I love that she's a clinical psychologist, I'm a clinical psychologist, you are a clinical psychologist, but we all do different things that speak to our individual passions and our callings. It's so important, isn't it? We are not just cookie cutter clinical psychologists.

Dr Shabnam Berry-Khan (: 18:41

I hundred percent agree with that. In fact, you could argue, I mean of my caseload, the bigger part of it is case management, which I didn't know about when I was training, that's for sure. And I think we can also lend our skills to not just therapeutic endeavours that there are other ways that we can use our skills. And I think that's the really exciting bit about being a psychologist in training now compared to back when I was doing it, it was a bit more sort of standardised if you like, but now I think there's a bit more acceptance that there are lots of different ways to do psychology and they're all legitimate and I think it means that you probably from training onwards, you get to think like that from the off. Whereas I think, I'm not sure that that was so strongly felt at least certainly I didn't feel that particularly strongly when I was training. So yeah, I'm kind of envious of trainees now in a way that if that's indeed how it's, which it sounds like it might be. But

Dr Marianne Trent (: 19:52

Yeah, I think the pandemic has really exploded and advanced all of this hasn't it, with the way that people are working and with their, some people have kind of myself included, no longer work for the NHS at all or other organisations. They might only be self-employed, but many clinicians are doing a little bit of both, bit of employed work and a bit of their own work as well. And it's I think encouraging us to use our psychology skills in ways that suit ourselves as well as the needs of our clients. And it's really empowering.

Dr Shabnam Berry-Khan (: 20:28

Yeah, absolutely. In fact, I had a call earlier today with someone who was interested in working as an associate for us and we provide quite a lot of information up to the point of deciding if we're aligned in terms of our interest. And one of her reflections was that it feels like not everyone can work in the field that you work in. And I thought that's exactly why we produce all this information. We don't want to waste anyone's time and we certainly do not want to put our clients in a position where they're working with someone who then pulls out because it's not a good fit for them. So in a way we are requiring our associates to kind of know themselves as well and know what their passions are, know what their interests are, and know that working certainly in our field with the systemic focus does require home visits for example.

(: 21:19

It does require creative thinking, training for care teams, psychoeducation for the families, all of that stuff. And in a way that if you can explain it and justify it through your clinical formulation, pretty much if it makes sense and there is that motivation from the client themselves, the funding will probably be there to be able to work through those challenges and those goals that have been identified, which is an incredible way to work. And you, I'm not in the NHS anymore and it's been a little while since I have been, but it does feel like it's almost very different. It is just very different to how we've been trained to work, I suppose. And so that creativity does need to be on point in a way, but at the same time you can work in similar ways in the NHS but just not for the length of time, I don't think.

(: 22:16

Certainly that's the feedback I've heard from associates that I've experienced myself, that it's not a sort of 12 sessions limitations due to funding issues or just the way the system's set up. It's so much more than that. And if it's justifiable and it makes sense to the client and it ultimately, as we often say with psychology, prevents other problems from happening a bit later down the line, it's worth front loading if you psychology support so that you prevent other things from happening later on and you get that stability, which obviously our clients need and deserve

Dr Marianne Trent (: 22:54

Anyone

Dr Shabnam Berry-Khan (: 22:55

In all five.

Dr Marianne Trent (: 22:56

Whilst none of us can control or predict the future, we have to be entering into this work thinking that we can go the distance. Because I'm thinking that some of these cases, maybe even, I dunno, five years is it, how long is the longest case you could work with or could it be longer than that?

Dr Shabnam Berry-Khan (: 23:18

Really good question. So my longest standing case management client, because it's a lifelong injury as you say, and I started working with them as a paediatric when they were a child. I have been with them for the last 14 years and it doesn't look like we're going anywhere. So we're talking very long term. Our treating psychology work is a bit different, but there are clients who, because of the nature of their circumstances and the complexity around them, easily a couple of years of different things working in different ways, so

Dr Marianne Trent (: 24:00

So for a case where you might be working with somebody with a legal team and case management for 10 years, ultimately the goal would be that there'd be some sort of settlement and then the case management aspect would stop or not. What does that involve?

Dr Shabnam Berry-Khan (: 24:17

Yeah, I mean it really depends. So it depends on things like what their experience was up to the point of settling, whether case management and the support they got was consistent and felt safe for 'em. It might depend on how well the evidence was collated up to the point of settlement because of course post settlement then the compensation will be whatever size it will be accordingly. But obviously if there isn't any data and the engagement hasn't been there in order to get that data, it might be that the compensation is a small award ultimately and that can't afford case management or other parts of the package. And so there are big decisions to be made at the point of settlement, but often if there is a case manager involved, an engagement is pretty decent from the clients and the family. And of course the case manager is able to get the relevant data from other parts of the system like the care teams and the therapy teams and can coordinate that. Well, more often than not the compensation will allow for the relationships to continue post settlement. And so because of the understanding that it's a lifelong condition that they would need support for life.

Dr Marianne Trent (: 25:41

Okay, so when you say data, it's making me think about something I heard on the Jeremy Vine show the other day where it's saying that currently there's some health workers taking, I think it's the government to the high courts over long, but that's very tricky because they'd need to be able to prove without doubt that this had happened as a result of they'd caught covid as a result of their work, that they hadn't caught it elsewhere, for example. So when you are talking about data, that would be the data that they'd be having to produce, which is very tricky to do because you can't know that for sure, you can say on the balance probability, but for that sort of case you have to be certain, is that what you mean by the data? Some stuff to back up your claim that it was someone else's responsibility rather than the person.

Dr Shabnam Berry-Khan (: 26:38

So when a case manager is involved, it's after the point liability being assigned. So that bit that you are talking about is quite early on in the sort of pathway and the lifecycle of a case manager's involvement. So once liability has been assigned to someone else causing the injuries, money is then released in order to allow rehabilitation to commence because all these cases can go on for years. Someone can't wait for rehabilitation for that long. So some funds are released and the idea is that those funds being released creates clinical data outcome data, it produces evidence to demonstrate that the client actually needs that support. And so that's the data. I mean that feeds back into the litigation strategy that then gets chewed over by the litigators and of course the defence solicitors to work out whether that's justifiable, whether that's not justifiable, whether that's been helpful, whether it's not been helpful. And that's partly why the legal case can go on for so long because you need to work out over a period of time just how much is needed. And obviously client's needs change, people can start improving and making positive changes, others decline because of health conditions that ensue after their injury, so on and so forth, complications and all sorts. And so there needs to be a reasonable picture over a period of time as to what has been going on. Does that

Dr Marianne Trent (: 28:24

Make sense? I'm with you. Yes. So the data might be, for example, actually physiotherapy five times a week and speech and language therapy twice a week is keeping this client rehabilitating and to withdraw that would be detrimental to their wellbeing. So we need to make sure there's enough budget for that to continue.

Dr Shabnam Berry-Khan (: 28:46

Absolutely. And the experts that come in and get that snapshot picture of the clients will have the view of across their lifespan. And so it needs to be scaled up for the X number of years that this person is expected to live. And unfortunately in some cases injuries can be life limiting.

Dr Marianne Trent (: 29:05

Okay, thank you so much for clearing that up for us and really clarifying and helping us paint that picture. Could you give us and our listeners your top tip for reducing burnout when you are an aspiring psychologist or mental health professional?

Dr Shabnam Berry-Khan (: 29:21

Yeah, I think so. My top tips would be whatever you do, make sure that there's space for you in that offer. And I think it's very easy to get carried away with your passions, with your interests for filling a gap in the market if you like. With all that enthusiasm, it's very easy to get to a point of recognising that actually I haven't built into this picture what I need in order to sustain all of that good stuff because the chances are if it's something you are doing, it's probably going to be benefiting other people. You don't want to do that for a short term, you want to do it for the long term. So be okay about building yourself into what that model's going to look like ultimately part-time, working full-time, working family commitments, so on and so forth. And I would say related to that, you don't have to do everything yourself asking for help sort of delegating to specialists out there that can help you. And I always use the example of a virtual assistant.

(: 30:37

I mean they are a godsend frankly. Having someone who can assist you to do the things that, let's face it, I'm no good at because I'm a psychologist, I can do that, but not so good at keeping my diary well that I thought we were meeting half an hour earlier than we actually were. People like me need a VA and I can spend a very long time focusing on things that get me stressed out, number one. And number two aren't going to get done well, let's be honest. And number three, takeaway from the actual thing that I can do, my specialism if you will. And so outsourcing is okay, it might cost, but it's worth doing that cost benefit analysis in terms of, well, what can I gain if I'm freed up for that hour? Yes, I'm paying X amount for someone to help me with that, but that also means that I can think about doing something else.

(: 31:26

And that's something else might not even be a business, something else, it might just be I can go for that walk that I keep saying I want to go and do. So those would be my two main sort of suggestions. I think they're not typical and ideas that you would kind of, there's not the go for a swim and go to the gym sort of ones. But I think for me, they've really helped ground me and helped me feel very sort of aware of what is important to me. But I think in, I suppose it could be a third thing, but it's kind of interlinks is just you start then finding people who are like you when you know what your values are and you're giving time for yourself to be able to be expressed and then you end up sort of connecting with people who that you align with. And that's a really nice way to live life. I think good people, good balance and space to do whatever you need to do as well because it is that oxygen mask on your face before you start helping other people's scenario, which I'm sure many people have said in your podcasts over the

Dr Marianne Trent (: 32:48

Years, it really matters. Doesn't

Dr Shabnam Berry-Khan (: 32:50

It really,

Dr Marianne Trent (: 32:50

Really matters.

Dr Shabnam Berry-Khan (: 32:52

That's my version of it. I would say. As it turns out, I am also swimming a lot more than I used to, which is really, really great. And that helps with that side of things as well in terms of physical exercise and that side of things.

Dr Marianne Trent (: 33:09

Brilliant. And if people want to know more about you and your case management or case management as a topic, I know at one stage you had a podcast called the Psychology of Case Management. Can people still listen to that?

Dr Shabnam Berry-Khan (: 33:21

Yeah, it's on the website. It's under our resources tab. Yeah, there's a whole load of information on there. There's various articles and fact sheets about working in the serious and catastrophic injury space with that psychological spin of course, because our jam at the end of the day. But yeah, it's a really great feel to, if anyone's looking for paid assistant work, case management's a really interesting feel that even if it's not psychology in the treating psychology sense, it's absolutely a field that you get to learn a lot about rehabilitation, brain injury, spinal cord injuries, et cetera, and systemic working ultimately

Dr Marianne Trent (: 34:05

Such important work. And you are over on LinkedIn, which is where I first connected to you, your company is called Psych Works Associates and on LinkedIn you are Dr. Shana Berry Ka with a, aren't you? So people can come and follow you there.

Dr Shabnam Berry-Khan (: 34:19

Brill. Thank you.

Dr Marianne Trent (: 34:21

I will make sure I link to all of that in the show notes, but thank you so much for helping illuminate me as well, but our watchers and our listeners about the work that you do as a case manager and for people with serious and catastrophic injuries, keep doing what you do. Keep lighting up my LinkedIn as well. It's lovely to see you again.

Dr Shabnam Berry-Khan (: 34:42

My pleasure. Thank you so much and all the best to your audience.

Dr Marianne Trent (: 34:46

Oh, thank you. What an absolute pleasure it was to meet Shabnam and I hope that you will go and follow her over on LinkedIn. If you are on LinkedIn, and you certainly should be come and follow me too. I am Dr. Marianne Trent everywhere. What has this episode evoked for you? What's it made you think? Do come and let me know in the Aspiring Psychologist community Free Facebook group, if you like this way of learning, thinking about novel and important concepts in psychology, including ethics, including formulation, including smashing interviews and application forms out of the park. Do please consider coming along and joining the Aspiring Psychologist membership. Don't forget the books as well, the Aspiring Psychologist Collective and the Clinical Psychologist Collective too. And if you are looking at how you can work out how to get qualified therapist check out Talking heads. My pleasure to bring you this podcast. The next episode will be available from 10:00 AM on Saturdays on YouTube and will be along from 6:00 AM as an mp. Three. Thank you for being part of my world. Take care.