AHPRA Notifications (with Dr Carollyne Youssef)

[00:00:00] Bronwyn: Hey, mental workers, you're listening to the Mental Work Podcast, your companion to early career psychology. I'm your host, Dr Bronwyn Milkins, and today we are talking about the notification process that is managed by AHPRA and the Psychology Board. This process plays an important role in making sure the public receives competent and ethical psychology services, but most of us have no idea what the notification process looks like or how to reduce our risk of receiving a complaint.

[00:00:32] In the psychology board's most recent reporting period, which was 2022 to 2023, just over 2 percent of practicing psychologists received a notification. So if you put a group of 50 random psychs together, it's likely that one received a notification in the past year. It sounds relatively small, but maybe over a career that spans several decades, the chances that you or someone you know will receive a notification increases a bit.

[00:00:58] Now, this is a topic that has been requested many times. Listeners have told me that they are terrified of getting into trouble and doing the wrong thing early in their career. They feel really paralyzed by this fear, and they've told me that they or their peers feel the same way.

[00:01:15] So the aim of today's episode will be to inform and educate you about the notification process, how you can minimize your risk of receiving a notification, the importance of accessing support during the notification process if you do receive one, and just a bit about what it looks like. We hope by the end of the episode that any myths, misconceptions you hold about the notification process are dispelled and you can go about your day as a psychologist with a lot less fear.

[00:01:42] To help me out today, we've got our guest here and her name is Dr Carolyn Youssef. Carol, so nice to have you on the podcast.

[00:01:50] Caroline: Hi Bronwyn, thank you so much for having me.

[00:01:52] Bronwyn: My pleasure. Could you please tell listeners who you are?

[00:01:55] Caroline: Yes, certainly. Uh, so, my name's Carol, I'm a forensic psychologist. I manage a forensic practice, um, and I lead a team of psychologists, um, in a practice called Psychorium in Sydney, New South Wales.

[00:02:08] Bronwyn: And could you tell us a bit about, I guess, your familiarity with the ARPHA notification process? Like what's your experience? What's your involvement here?

[00:02:16] Caroline: Yeah, so I also, as well as doing assessments and, and therapy, I also do a fair bit of supervision. So I'd say probably for the last, I'd say just over 10 years, I've been doing a fair bit of supervision and it's through that process that I've come to have a lot of exposure to the notification process and complaints through AHPRA and just assisting and supporting psychologists through that process, as well as other professionals actually who come under AHPRA.

[00:02:43] Bronwyn: Not only psychologists, but other professionals who are regulated by AHPRA.

[00:02:47] Caroline: Yes.

[00:02:48] Bronwyn: And so you've been doing that for about over 10 years?

[00:02:52] Caroline: Yes, yes, I've been doing, I've been supervising, um, just over 10 years. Um, and I'd say particularly in the last few years, I've, I've, I've had a lot more exposure. Yeah.

[00:03:01] Bronwyn: You've had a fair bit of exposure and I imagine that you will have seen many different types of notifications and have gone through, I guess, quite varied processes.

[00:03:10] Caroline: Yes, absolutely. Yeah.

[00:03:12] Bronwyn: So we're extremely grateful to have you on board. I'm so grateful that we can have someone with your knowledge and expertise to help us out. Usually that makes guests very uncomfortable when I point out their expertise, but hopefully that's okay. But yeah, listeners, this is going to be a really, um, information heavy episode, but yeah, I really hope it will be helpful for you. Cause yeah, just a lot of folks have a lot of anxiety about it. And I'm sure you've seen that in your practice as well, Carol. Yep.

[00:03:38] Caroline: Definitely.

[00:03:39] Bronwyn: So maybe we can start off by just talking about like, what are the aims of the AHPRA notification process? Like what are they trying to achieve?

[00:03:47] Caroline: Well, I suppose when we look at what AHPRA is primarily trying to achieve through that process, it is actually ultimately about public safety. That's probably the main thing that they're after. And so when a complaint does come through or a notification comes through, very much their task is to investigate that, just to ensure that the public is safe. So that's really what it's about, and just to ensure that everyone regulated under AHPRA. I suppose is abiding by our standards, our, you know.

[00:04:16] Bronwyn: Yeah. So maybe the first misconception we can kind of address is that some people think that it's supposed to be punitive. Like it's supposed to be really punishing this process. Could you just speak to that please?

[00:04:27] Caroline: Yeah, look, absolutely not. Although I can totally understand how it would feel like that. I think any time we do anything wrong, I mean, even if you get pulled over, say, or get breath tested, I think people automatically get really nervous and think, Oh my God, I've done something wrong.

[00:04:41] This is no different. In fact, this might be a little bit more intense as well, because our career potentially is. on the line, I guess, when something like this comes through, first thought is, Oh God, I'm going to get deregistered. My, you know, my whole career is, is, you know, out the window, but no, it's not.

[00:04:57] It's, it's initially when you get that notification, it's an inquiry, essentially. It's saying, Hey, we've become aware of this. This has come through. We just want some further information. So it's very much just providing you that opportunity to, I guess, put your side forward. Um, but it's not intended to be punitive. And in fact, one way to look at it might be almost protective, I suppose. It's just looking at being protective.

[00:05:23] Bronwyn: Yeah. That's a really great way of putting it, that it can feel like you're in trouble. I was actually reflecting on this in preparation for the episode and I was like, why might psychologists feel like they're in trouble? And I reflected on us as a cohort and I thought, okay, look, you know, you're... usually we've achieved very high grades to get into this profession, so we're kind of used to, I don't want to say being goody two shoes, but I kind of do. So we're used to being very, uh, very good at what we do, following the rules, um, and, and this can feel very, very scary.

[00:05:55] Caroline: Yes, absolutely. And that's exactly right. And I think our unrelenting standards and perfectionistic tendencies, which we all can relate to, automatically feels like, yeah, we've done something wrong. We've overlooked something. And I think panic can sometimes set in.

[00:06:09] Bronwyn: Uh, totally, absolutely. So, uh, You mentioned before that when, I guess, a notification is received, AHPRA will contact you and they'll, I guess, respond to the notification. Could we just take a step back and talk about who makes notifications?

[00:06:26] Caroline: Absolutely, so essentially anybody can make a notification. So it could be your, your client, it could be a family member of a client, it could be a spouse, um, it could be, it could be a friend of theirs, it could be a fellow, um, clinician who might have concerns. So it really could be anyone who, who can. So anyone's entitled I suppose in that sense to put forward a notification. Uh, and it's um, either over the phone or online. Uh, so yeah, so that's, that's typically, I guess, who makes notifications. I think my, from memory, it's the majority of the time it is a client or someone associated with your client.

[00:07:07] Bronwyn: Yeah. So the stats from the 2022 2023 report said that 72 percent of notifications when made by a patient relative of a patient or a member of the public, uh, 13 percent were from another practitioner, 4. 5 percent an employer and, uh, 1 percent board initiated. That's interesting. Like, do you know what that means?

[00:07:28] Caroline: I have no idea. Actually, I did see that. I was looking at the stats and I was like, I do not know what that means. But, uh, yeah, I don't know what that is. I'm, I'm, Yeah, I'm curious. I was curious about that.

[00:07:38] Bronwyn: Yeah. I guess one thing I'm thinking is that some practitioners are terrified of say, going to a GP, getting a mental health care plan, and then the GP will report them for being impaired. Could you just speak to that?

[00:07:52] Caroline: Oh God, that comes up so much, um, that fear. Yeah, it does. It does actually. And interestingly for those who have received a notification when they do develop. I guess depression or anxiety that becomes unmanageable, there's then an anxiety about seeking further assistance in case that actually results in another notification, which is really sad to see that.

[00:08:13] But, um, look, in terms of impairment or being impaired, which is one of the reasons that someone might lodge a notification, you need to be substantially impaired for that to become something that is going to be investigated. So, feeling depressed, feeling down, not being able to sleep properly, losing your appetite, those sorts of things that are very normal when a notification comes through would not be grounds, I suppose, to amount to substantial impairment.

[00:08:40] Bronwyn: Yes, and that's what I was thinking. I remember a few years ago, like, um, maybe there was a change in New South Wales or another state, but I remember they, they made sure the threshold was very high and it was made clear to medical practitioners like, look, yeah, somebody coming in and being like, I've been feeling sad, um, is not reason to report them for impairment.

[00:09:01] Caroline: I mean, I think the impairment, the threshold means it needs to interfere with your work. It needs to significantly interfere and, yeah, most of the time this wouldn't significantly interfere with one's work.

[00:09:13] Bronwyn: No, that's good to know. That's reassuring to hear.

[00:09:15] Let's just go through then the steps after a notification. So again, you mentioned that the board will contact you after a notification has been lodged. Could you just tell us what happens after that?

[00:09:30] Caroline: So, I guess there just the step before this. So a notification comes through to AHPRA and depending on the jurisdiction that you're in, it then gets referred to the relevant department that deals for example, in New South Wales, it's the HCCC, so the Healthcare Complaints Commission. So they're the ones that will then take carriage of that and then they will actually contact you. So I think like ACT and Victoria, it goes through... oh, there's another one that it goes through. I cannot recall. I think it's the Health Complaints Commission.

[00:10:02] So each, yeah, so each, each, I guess, jurisdiction has its, its unique, um, reporting body. So it goes to them. They will usually send you an email alerting you that a notification has been made. Um, and they'll usually give you a copy of that notification, um, and ask for a response from, from the clinician.

[00:10:24] Bronwyn: So then, okay, cue panic, um, so, uh, who, who should I contact? Who's the first person? What should I do here? They've asked me for a response. What do I do next?

[00:10:36] Caroline: Yeah, absolutely. So, um, panic stations set in and look, I would, I would strongly recommend, um, supervisor at least to contact your supervisor and your supervisor should hopefully tell you go to professional indemnity. Contact your professional indemnity, let them know. It might be a little bit different depending on whether you're in a government organization versus private practice. So I think with private practice it certainly would be a little... you know, debrief with your supervisor and then immediately alert your professional indemnity um, as soon as possible and they will likely connect you with a solicitor.

[00:11:10] Bronwyn: So does that differ if you are in solo private practice or a group private practice?

[00:11:15] Caroline: So I, I, I didn't think, yeah, I don't think that it would.

[00:11:20] Bronwyn: No, me too. Yeah. It's just, um, listener were asking us about the difference between like group and solo, like how that would be handled, but I think it'd be quite similar. It'd be, you contact your supervisor. They would also share with you, contact your professional indemnity insurer. Um, indemnity insurer would be like, we've got these lists of solicitors that, um, we have through us, um, and we'll put you in touch with them or you contact them.

[00:11:42] Caroline: Yes, yeah, absolutely, absolutely. I think perhaps it may be like a government department, they might have their own internal legal branch that deals with it, but either way, I think, once a notification comes through, it does ideally need to go to a solicitor to kind of deal with.

[00:11:58] Bronwyn: We wouldn't want to reply straight away before contacting the indemnity insurance and the solicitor, right?

[00:12:07] Caroline: Ah yes, that's right, that's what I would recommend and that's certainly what I recommend as a supervisor and what I've seen people do. So, and your professional indemnity I think would also strongly advise, or the solicitor would strongly advise not to respond right away.

[00:12:21] Bronwyn: Yeah. Okay. Great. So then what happens?

[00:12:25] Caroline: So depending on, I guess, the nature of the notification or the complaint at hand, what will likely happen or what I've seen happen is the solicitor assigned will ask for a copy of everything. So we'll ask for a copy of the letter you've received, um, the details of the complaint. They'll have a chat to you about what's happened, what your thoughts are. Has anything come up previously? Let's assume it's a client. Were there any indications that this client, um, or a family member of the client, for example, was unhappy? Um, had they raised this with you before? So they want to gather as much information as possible. Uh, and then, again, if we use the example of, say, a client, uh, I believe that the file will usually be requested at that point. Um, so the solicitor will ask for that, yeah.

[00:13:12] Bronwyn: So I guess that speaks to the importance... like it is a requirement that we always have. I'm going to get this word wrong, but contemporaneous. Yeah. Wow. I said it. So it is important to have up to date notes, but I guess this just speaks to the importance of having up to date notes, like really make sure you document things.

[00:13:29] Caroline: Document, document, doc, I can't, I can't stress that enough, absolutely. Like if it's not in, so there's a saying that I have in my practice, if it's not in the system, it didn't happen. And there is something about that. So they will rely very heavily on the notes that you've got. Um, and that'll be the first, the first thing that they'll kind of look at.

[00:13:47] Bronwyn: Okay. So a question that we did have from a listener was, do my notes always ask to get submitted?

[00:13:53] Caroline: Yeah. So that's a, that's a really good question. So my understanding of people who have had these notifications is the file is always requested, at least by the solicitor. And the advice that multiple solicitors kind of, I've heard back as kind of from my supervisees is that they almost always do recommend forwarding it to the HCCC for example, to forward it for them to look at it.

[00:14:18] Because what can happen, and I am aware has happened, is if the psychologist doesn't have adequate records, it actually sparks another kind of concern that kind of looks at inadequate note taking. So that's my understanding of that. There may be cases where that's not always required, but there's certainly the cases I'm aware of, the file, the solicitors sort of looked at it, and that's been sent through.

[00:14:45] Bronwyn: yeah. And what are they looking for when they receive that file? Just in general? I mean, obviously like we're just talking about a general complaint. So I don't know if there is a general complaint, but yeah. Yes.

[00:14:56] Caroline: I mean, they're looking at public safety. They're hoping that we're acting in accordance with our ethical standards. They're probably looking to say, okay, this is a client of yours. Um, have you got consent, um, there, have you, have, have you got a treatment plan, do we see regularity there, do we see adequate note taking so that we can get a gist of what treatment you are providing, if there are any issues that have come up, is that documented and how have you tried to remediate that either with the client or maybe, you know, in your own research or supervision, so I, I gather that's what they're saying, I mean these are kind of assumptions on my part I suppose, I don't know exactly what they're looking for but that would be. That would probably be my assumption around what they're looking for.

[00:15:37] Bronwyn: Yeah, I've read a few tribunal reports and hearings, and I think it's been mentioned in there, but in general, like you say, like, they want to know whether you've got a treatment plan, a formulation, whether you're keeping notes for every session, whether you've got a treatment plan that makes sense given your formulation. I think they also like to make sure that you're using evidence based treatments. And that's important.

[00:15:59] And let's have a look at the potential decisions AHPRA can make. So they've asked you for a reply and then the board meets and assesses that reply, right?

[00:16:10] Caroline: Yeah, so I think they, they assess it and I, I wouldn't know more than, I think it's more than 60 percent will kind of conclude with no further, no further, um, action required, I suppose. So if it goes back and they have a look, they see the files are there, there's adequate information, it seems that there's no real, you know, concerns there, then um, the matter might be resolved.

[00:16:34] If it's not, however, then, uh, being a psychologist it usually then gets referred, my understanding is it gets referred to the psychology board, so they kind of will then, um, look at it. Though that depends as well, so I will say that there are rare circumstances, um, so while you're going through this... for the most part, you can practice and everything's kind of functioning as per normal. There is, um, the exceptional cases though where they might have an immediate kind of, where they might, you know, prohibit immediate action, that's right, where they might say, no, actually the concerns are so significant for us that we're actually going to order you not to, ask you not to practice psychology until we've investigated this.

[00:17:18] So there is that kind of Yeah, that subgroup I suppose, again that's on the, it's the rarer, it's a rare one. But um, for the most part you continue practicing as per usual and then it, it, they might try to remediate it, so there are several steps I think in between where depending on the, the organization that's managing it, so HCCC for example, they might try to remediate it, try to come up with a solution.

[00:17:43] If not, or if it seems that the concerns require a little bit more, um, attention, then it gets, yeah, referred to the, to the board. There are some times, though, where, for example, if there are concerns that there's criminal activity, for example, it gets referred to the DPP, the Director of Public prosecutions. Um, or it can actually also end up in the tribunal in the more extreme cases as well.

[00:18:08] Bronwyn: Yeah. So I'll read out the stats around that. So we've got, um, Um, yeah, like you said, over 60 percent have no further regulatory action. So that's 65 percent and 13 percent are referred to another body or retained by health compliance entity. So that would be the H, HCC and, um, the New South Wales one.

[00:18:27] Uh, 0. 7 percent have registration suspended or canceled. So that's 0. 7 percent people, very small. Um, 7. 1 percent cautioned or reprimanded and 13 percent have conditions imposed on registration or an undertaking accepted. What's the difference between conditions and an undertaking? Do you know?

[00:18:48] Caroline: I'm more familiar with people who've had conditions imposed on them. This is where the board sit and go, okay, we want you to have supervision every fortnight and part of what you're going to address in supervision is your note taking and your, your treatment plan and your case formulation and they might have very specific kind of outlines there.

[00:19:06] Bronwyn: So a question we had from listeners was about the conditions on registration. So I think you've just answered it because the question was, what does this mean? So it might be, um, supervision or an educational professional development requirement, like it might be take a course on professional boundaries and ethical decision making.

[00:19:23] This is a question from listeners as well, but they asked is this reflective of us as professionals? Maybe you could speak to that. Like, do you feel like having conditions on our registration is this reflective of us as professionals? I wonder if they're asking, does that mean I'm bad?

[00:19:35] Caroline: So no, it definitely doesn't mean you're bad, that's for sure. Is it reflective of us as people? Now that's a, that is a really interesting question. I think it perhaps might be reflective of the practice at that point in time, but then remediations are being put in place to improve that.

[00:19:51] Is it reflective of you as a person? No. Is it reflective of you meaning that yeah, you're a bad person or you shouldn't be a psychologist? No, I don't believe so. I think if they felt you weren't fit to be a psychologist, then they'd let you know. I don't think they kind of, you know, beat around the bush there. But I do think it's about that reflection, that reflective sort of practice and self reflection and self improvement. And we're constantly doing that, I suppose.

[00:20:17] Bronwyn: Absolutely. Thank you.

[00:20:19] And what do we say to clients if they see conditions? Because conditions get put on our AHPRA profile. Anyone can look us up. What if a client sees conditions? What do we say to them?

[00:20:32] Caroline: I mean, that's, that's, that's a really good question. I mean, I, I would say being as honest as possible because it is, it is, it is there for the public and it is meant to inform the public. So I suppose being as transparent as you feel you possibly could, um, and perhaps saying that, you know, there was a review and they found that there were areas of improvement and so you're working on that. And these are some things that you might be doing, you know, you might be doing extra supervision, just to ensure that you're delivering the best service that you can.

[00:21:03] I mean I don't think we can shy away from it and I think the whole purpose of this is about the public being made aware. So I think if a client does raise it, I do think it's about being, yeah, as transparent as you can. And also I guess it would demonstrate to the client that we are human and that we, we can work on, on self improvement and remediations and that's not such, that's not a bad thing.

[00:21:26] Bronwyn: Yeah. So really ownership of the, of the, I guess, if there was a mistake that was made or areas for improvement that were identified, just owning that that's quite a normal thing that everyone has. Um, these were just an area of improvement that was picked up through this complaints process, which is there to protect the public. Um, and you are going through some education and professional development to help improve those areas.

[00:21:51] Caroline: Absolutely. Yeah, absolutely.

[00:21:54] Bronwyn: Okay. So, maybe we could move a bit onto the consequences for the practitioner. So, I guess just from your observations as a supervisor and maybe just your general knowledge, how does being under investigation affect a psychologist personally and professionally?

[00:22:12] Caroline: Yeah, so it has, it can have quite a significant effect. So if we start with, I guess, certainly personally, you do have a lot of that, um, almost like an existential crisis, to be honest. Sometimes that can happen and, Am I meant to be in this profession? Um, maybe I was never meant to be here. You could get the imposter syndrome that really kicks in. I mean, it never really goes away, let's face it, but it would really kick in.

[00:22:36] Um, people will also tend to experience that depression and anxiety. So people often will say that they become more hypervigilant at work, more cautious, just more unsure of themselves, lots of second guessing. I mean, yeah, people become quite distressed about this and can become quite depressed by it.

[00:22:57] I think it's also very isolating for people. People often speak about a lot of shame that they feel, a lot of embarrassment. They worry about judgement from their colleagues. They end up kind of not wanting to say anything. So there's that secrecy that kind of breeds that kind of fear. Yeah, it kind of perpetuates that shame that they have, which is, it's really sad, yeah.

[00:23:22] Bronwyn: Yeah. So yeah, they can feel quite isolated and go through their own mental health struggles as a result of this process. I'm curious about, uh, reputational damage. I reckon this would be a fear of early career psychologists that everyone would know and all their colleagues would abandon them and they'd never have any work ever again. Uh, and they'd be forever branded as a bad psychologist. Could you just speak to that?

[00:23:48] Caroline: I mean, I think when people, um, are able to talk about this, I think they often, one thing they report to me is, oh Carol, people are actually quite empathic around this, and if anything, their own anxieties when they disclose to their colleagues, kind of, comes up and they're like, oh my goodness, I'm so worried or anxious about that happening to me. Um, people are usually quite curious about the process because they're not always sure of it.

[00:24:11] So I think in terms of branding you as about psychologists. I mean, I've not seen that for anyone who has gone through this process that that's been their experience, even though that might be their fear. Um, and I guess generally speaking, most people, I guess, wouldn't know unless you share it. And when people do share it They've very, very few people feel that they've been, I guess, ostracised or rejected or shunned after sharing their own experience of that.

[00:24:39] Bronwyn: This might be an unrelated tangent, but it's something that just came up in my head. But something that I've observed is that when I have seen it talked about on social media, when I have seen people be like, I've been through a notification process, what I've noticed is that those types of notifications, they tend to be of the type that are vexatious. So the person on social media will be like, it was completely unfair. Like, I did nothing wrong. Um, this person came after me and I don't... I wonder if I've ever seen somebody say on social media, I had a notification and I made a genuine mistake and I, and I wanted to better improve myself.

[00:25:17] Um, I don't really know what I'm asking you to comment on, but maybe I'm trying to point out that like, it's maybe that's that shame that it's like around making genuine mistakes that we only feel like we can admit if we've had a notification if it was vexatious. Whereas with a genuine mistake, maybe we're like, oh, that's too shameful for me to share. What do you think?

[00:25:38] Caroline: Well, therein lies one of the issues, Bron. I feel like that's actually one of, one of the issues and that's what further stigmatises this, is that people won't, I can only say, I feel like if people started speaking about that more openly, it would destigmatise this and it would open it up for other people to go, Oh, actually, yeah. This has happened to me and this was my experience.

[00:25:59] I agree with you. I do think that the only time people perhaps feel comfortable talking about this are the vexatious ones. Um, and look, the vexatious complaints certainly do happen, but they are quite rare. I mean, I think less than 1 percent of complaints are of the vexatious nature. But, um, yeah, I agree. I think, I think I get what you're trying to say in that I think if people were perhaps more open, it would lessen that shame and the stigma.

[00:26:25] Bronwyn: Yeah. I think that's what I'm trying to get at is that I wish that we would have people talking about their notifications of the type where it's like, look, I didn't keep adequate records. I acknowledge that now that was a mistake. I've taken substantial education to improve that and I'm really proud of the way that I take records now.

[00:26:44] Caroline: Absolutely, absolutely. Because that, I guess that remediation process is about that improvement, you know, and I sometimes have found that people who have been through the notification process are a lot more on the ball because if some things happen and they're hyper kind of aware of things, then perhaps people who haven't gone through that process.

[00:27:04] Bronwyn: Just circling back to the reputational damage, I guess what I'm hearing from you is some reassurance that in your observation, when psychologists who have received a notification open up to their colleagues, the overwhelming response is empathy.

[00:27:19] Caroline: Yeah. Yes, absolutely. Yeah.

[00:27:22] Bronwyn: That's, really good for listeners to hear. It's not like, Oh my God, how terrible are you? I can never talk to you again.

[00:27:28] Caroline: No, no, I think it's, and I think people then share their anxieties about that process, which actually validates the angst that the person who's had that notification is already feeling.

[00:27:38] Bronwyn: Yeah, Yeah, no, that's really good to hear from, yeah, your observations and experience.

[00:27:43] So I guess a practical question is like, I guess this is, you know, how long is a piece of string, but how long does the process take, like the entire notification process and

[00:27:54] Caroline: So, yeah, so I, I believe that initial, so I suppose there's two stages, um, generally. There's the, the assessment stage and then there's an investigation stage if it does proceed to that, um, level. So I believe that they try to do the assessment stage within 60 days, roughly, a couple of months. Um, people have indicated that they're actually slightly longer sometimes, uh, but that's the initial stage.

[00:28:20] If it goes to, um, investigation that can take longer, And that really does depend on the nature of the issue at hand. Uh, I have heard of it going for like a year over a year. Like it can, it can go for a little while.

[00:28:38] Bronwyn: Yeah, okay. Maybe we can jump off that then and talk about the importance of support like getting your own support during this time with what can be quite isolating and prolonged process. Um, what are some of the supports you would recommend psychologists who have received a notification set up for themselves?

[00:28:58] Caroline: So I would start firstly with supervision. So hopefully people feel like they have a supervisor who they can connect with and be open with about this. Um, having collegial support. Um, if, if that's not feasible, then at least personal support. So family, letting family, and or friends know what's going, what you're going through so they can support you.

[00:29:19] And if you do need to see, see someone or speak to someone, absolutely, there's no shame in that, to go to your GP, get a referral, to see a psychologist or a counsellor. And in fact, I believe the Black Dog Institute, I'm not sure if this is nationwide, but I think they have a service for, um, allied health professionals.

[00:29:40] Bronwyn: Yeah. Okay. So yeah, really getting that social support is so important.

[00:29:45] Caroline: Yes, absolutely. And, and I guess that self care, looking after yourself, if you need a little bit of time out, if you're really kind of struggling to kind of be kind to yourself. And take that time out so that you're not, you know, getting sick. For example, I see people often get quite physically sick because of the level of stress. So just that self care, being mindful of that.

[00:30:05] Bronwyn: Yeah. And what about like, if your confidence is just completely shattered and you're like, okay, I just got to leave the profession. Like, um, I feel like that might be an understandable response for some people due to the stress. But I imagine as a supervisor, you might be thinking, look, this is a competent practitioner who's had a bit of a setback, like, you know, like I'd hate to see them leave the profession.

[00:30:25] I suppose my question is like, how do you, how do we help practitioners rebuild their confidence after receiving a notification?

[00:30:32] Caroline: Yeah, look, I mean, I think it, I mean, this is going to sound like a bit of a cop out. Sometimes time helps heal that process. It's a process that, you know, I mean, you kind of, you're there, you remind them of their competence, you remind them of, you know, all the good work that they've done.

[00:30:49] Sometimes it is about time, sometimes it is about they feel, well, actually, I, maybe I do want to consider my CPD. Maybe I do want to actually now upskill in another area and looking at it as a self growth, I suppose, that growth mindset sort of stuff and encouraging them. I mean, I'll encourage people if that's what they want to do to do that. But just balancing it with this doesn't mean you're a terrible psychologist and people do tend to default to that a fair bit when a notification comes through.

[00:31:17] Bronwyn: Yeah. Like, have you observed like any, uh, post traumatic growth, I guess, in psychologists, like that have been able to shift around their mindset and be like, look, this is an opportunity for me to grow from this. Does that happen?

[00:31:32] Caroline: It does, bron. Honestly, I think it does. I do think it does. I think if they've got the right support around them, absolutely, I do think that that can, can happen. I think the people who feel perhaps less supported are more at risk of that lingering on, that, that kind of, that negative emotional state lingering on.

[00:31:51] Bronwyn: Like shame, you know, just, it just festers in isolation, doesn't it?

[00:31:56] Caroline: It does, absolutely. And it inhibits that growth. That's, I mean, we know this about shame, you know, so. When, I mean, that shame is, we understand where that comes from, but trying to shift people away from that shame so that they can grow and take, you know, that learning nugget from this. I feel like every experience we have, no matter how adverse, there's room to grow and learn something, and just looking for that.

[00:32:17] Bronwyn: Yeah. Thank you for that hope as well, Carol. That's nice. So a bit of a side question, but if somebody is mandated to attend supervision, so they get conditions on their registration or as part of the investigation, they have to attend say supervision once a month for six months. Um, could you just tell us a bit about what the supervisor's role in that is?

[00:32:39] Caroline: So the supervisor's role in that would be, um, I mean, they would be aware, um, of what's happened, and in terms of meeting those areas of competency that might have been flagged as requiring um, a little bit more work or a little bit more enhancement and they'd work to that.

[00:32:55] Bronwyn: I've read that if you are mandated to attend, then you need to give like monthly reports to AHPRA or say like, you know, once every three months or whatever. I presume that the supervisors need to also report back to AHPRA on the supervisees progress.

[00:33:10] Caroline: Yeah. So I've received people more kind of in that voluntary sort of capacity rather than kind of...

[00:33:16] Bronwyn: the mandated.

[00:33:17] Caroline: The mandated one. So I do know that there is regular reports from the supervisee, but it would make sense for that to also be the supervisor as well, who has to report on that.

[00:33:28] Bronwyn: Yeah. Um, and I guess like maybe a fear that psychologists might have is that, um, my supervisor is just going to be an, an AHPRA in like sheep's clothing kind of thing. Like they're going to be very punitive and critical. Um, could you just speak to that?

[00:33:44] Caroline: So look, I mean, ideally that wouldn't be their stance. I think what I will speak to is feeling comfortable with your supervisor. I think that is really, really important. I think if for some reason you don't feel safe or you don't feel comfortable with your supervisor, then you need to kind of let that be known and perhaps look at that.

[00:34:03] Because I have seen people who've had supervisors where they've not felt comfortable. Safe with them or comfortable with them and that can actually be quite detrimental. So, ideally you don't feel that about your supervisor. But if there is something about that dynamic that's leading you to feel that you, yeah, you're, you're anxious around your supervisor, then maybe it is about speaking to someone and kind of looking at that.

[00:34:26] Bronwyn: Yeah. And you know, when I reflect on that and think about, well, consider how I think about it for clients. I'm like, yeah, if I was judgmental in a session and, uh, I feel like of course that would impair my client's ability to be vulnerable with me and to grow in, in this counselling process. Um, so I feel like the same would be true of supervisees that they would need to feel safe and that they're not being judged, um, that this is a genuine partnership geared towards their growth.

[00:34:54] Caroline: Absolutely. And I think particularly for early career psychologists, I would understand if they feel especially anxious about saying anything, whether they like it or not. Go with this because I don't want to get in any more trouble, but I actually think that if, I mean, you could try talking to your supervisor about if there is something in that relationship that's leading you to feel uncomfortable and see if you can address it together, but if not, then going elsewhere.

[00:35:18] But as a general rule, I mean, no, ideally your supervisor is not wanting that for you at all. They're actually wanting you to get through that, you know, that supervision process and then continue on into practice.

[00:35:29] Bronwyn: Totally. And maybe one other practical question is that would I need to tell my employer if I've received a notification?

[00:35:38] Caroline: Yeah, so there are some rules around that in particular. So, um, your workplace will have its, I guess, its own rules. Um, I know that the, say, for example, the HCCC or AHPRA, if there are conditions imposed, I do believe they, they, um, Do you need to let your employer know about that?

[00:35:59] As a general rule though I suppose that level of transparency would be ideal just to let them know but it's an interesting one that

[00:36:07] Bronwyn: Yeah, I was going to say I could see that leading to a rupture if say like you didn't tell your employer and then they see the conditions on your profile and they're like, uh, hey, so you've got a notification.

[00:36:18] Caroline: it wouldn't go down well so I think as a general rule perhaps let your employer know that this is happening keep them apprised of that so even if you're in a private practice Whoever that, um, you know, the practice manager is or the principal psychologist, if there is one, letting them know, um, that this is happening and just keeping them up to date.

[00:36:39] But I do believe if there are conditions imposed that your workplace does get notified. Certainly, I, I, in a, in a, I think a larger government organisation that happens in that, I, I think that would be the same anywhere else, yeah.

[00:36:52] Bronwyn: I, I wanted to address another listener question about this, which is how can early career psychs reduce their risk of receiving a notification? I think, yeah, this is quite a common one amongst, they just, they don't want to borrow of the process. How can they avoid it?

[00:37:07] Caroline: Yes, sometimes it cannot be avoided. However, however, there are things I think that can be done that might mitigate some of that. So things such as being really transparent with your clients or the consent process is imperative. So being really clear with that initial stage, what it is that you're willing to do. Um, either not willing to do or unable to do, so being really clear around your competencies and the focus of therapy, um, addressing any queries as they arise, um, if there is a grievance early on or a complaint that might go kind of more in house, dealing with that swiftly, um, and trying to reach a resolution.

[00:37:48] I do kind of think sometimes conflict avoided is conflict magnified. And I do feel like if there is something that comes to light, and sometimes there is, to kind of try to troubleshoot that early on. I think it's about also just basic things such as ongoing supervision. And if you are having a challenge with a particular client or a family member of a client, you know, raising that early on in supervision and getting a lot of guidance around that.

[00:38:16] Uh, note taking is really, really big, so just making sure that you're documenting things, you're documenting phone calls, you're documenting, um, emails that are coming through, whatever it might be that, that kind of documentation is, is up to date, um, and up, updating your treatment plan. And if you are stuck with someone, um, or you're feeling counter transference is kicking in, maybe something's going on for you, just addressing that in supervision and getting guidance around that, and then mitigating that as much as is possible.

[00:38:46] Bronwyn: Yeah. Beautiful. Can I add to that documenting your ethical decision making processes?

[00:38:51] Caroline: absolutely.

[00:38:52] Bronwyn: Yeah. Um, cause I feel like, yeah, if, if anything does come up and you do have a discussion with a client and I don't know, let's just say that they want to get a coffee with you outside of session. and they ask you in session, um, documenting exactly how you responded. referencing the APS code of conduct? And referencing the importance of managing boundaries and this is how you decline and this is how you're going to manage that in the future, um, I feel like could be important.

[00:39:22] Caroline: Absolutely. Anything like that. Whether you get a gift, for example. Whether there's a request like that. I think there's a range of things. Whether you're going to terminate someone. Maybe there's a decision to, for example, decide to terminate therapeutic work with someone for various reasons. Documenting that really well. So I absolutely agree with that. And even in supervision, if you discuss it, Kind of having a really well documented note of that, the rationale, when you discussed it, what the issues were that were discussed, so that you can keep that just in case something does come up.

[00:39:53] Bronwyn: Yeah, that I've gotten so much better at that. So like when I first started out as a psych, I used to just scribble down a few things like from supervision and now I have my little page and then I've got a summary of clients who I've talked about and then I've got what we talked about and then our outcomes and it's very, it's, I make sure it's good for this exact reason because I'm like it's very important to document who I've talked about, what the processes I've gone through.

[00:40:15] Caroline: Yeah, because they want to see that we are kind of seeking supervision, we're seeking kind of that collegial sort of support and case consultation.

[00:40:23] Bronwyn: Yeah. um, and I'll read out the stats around the most common types of complaints. So with the top one is actually clinical care. So that was 23 percent and then we've got 15 percent communication. What do you think some complaints about communication would be?

[00:40:38] Caroline: So communication might be, I wonder whether it is kind of inadequate communication perhaps with, with clients. Um, I wondered whether communication with confidentiality is what, or is that a separate category?

[00:40:49] Bronwyn: There's, oh, there's a separate category for confidentiality. Yep.

[00:40:52] Caroline: I think communication might be, um, inadequate communication, not communicating enough with clients because there are complaints that can come through if clients feel you're unresponsive. Well, they're trying to contact you and they're not getting any answers.

[00:41:05] Bronwyn: Yeah, okay, sure. So maybe like, um, you left a workplace and you didn't tell them that you were leaving and then they're like, where are you? And I can't get in contact with you.

[00:41:15] Caroline: I'd say so, and it might even relate to, and again, this is me perhaps hypothesising at this stage, but whether it's also communication with other professionals as well. I wonder if there's no contact with the GP, for example. There's no letters that are being written. Um, and so there's a lack of communication there in terms of clinical care.

[00:41:32] Bronwyn: Oh yeah. No, good point. Okay. The next topmost category was documentation at 12 percent and then 10 percent boundary violation, 5 percent confidentiality, 34% Other. So helpful.

[00:41:45] Caroline: It's quite broad.

[00:41:46] Bronwyn: Yeah.

[00:41:46] Caroline: Okay.

[00:41:47] Bronwyn: Yeah. Um, but I think all the things that you've said, Carol, really speak to the categories that are named. So making sure that you do have a treatment plan, that you're using evidence based interventions or assessment methods, you're communicating well with your clients and with other people involved in their care, you're keeping up to date documentation, you're not Violating boundaries and you're upholding professional boundaries. And yes, you are maintaining confidentiality, just knowing your privacy obligations around that as well, right?

[00:42:15] Caroline: absolutely, absolutely, yeah.

[00:42:18] Bronwyn: Yeah. Um, are there any other ways that early career psychs can help mitigate the risk of receiving a complaint?

[00:42:24] Caroline: It's very difficult to guarantee that nobody will, I think you can take all the steps that you can and ensure that your work is, you know, in accordance with our ethical guidelines. If a complaint is going to come through, though, we can't really prevent it. Um, and it is, it is people's right, um, to put a complaint through or a notification through if they're unhappy with something.

[00:42:47] What I would suggest, though, is that, um, Particularly early career psychologists educate themselves on the process. So there are some resources online. There is information on your, whether it's say, HCCC if you're in New South Wales, or the Human Rights Commission, um, depending on where you are. And actually looking at that process, which doesn't make the monster so large, if you know what I mean.

[00:43:10] You kind of read it and look at it, look at the stats, look at the process, look at what might be going on. Um, required of you, even if you're not currently going through a notification, I feel like that knowledge takes the edge off because I feel the unknown just heightens that anxiety.

[00:43:25] Bronwyn: Absolutely. I completely agree. And I know there's some info on the AHPRA website and the psychology board website, which outlines the complaints process. And there's also some advice around how to implement a complaints management plan policy and process in your own practice? So I think AHPRA is that wants you to be able to manage complaints in the first stage like in house if possible. Of course, it's a patient's right to make a complaint to AHPRA but if you can manage that in house that's also helpful.

[00:43:54] Caroline: Absolutely, absolutely, yeah. And I think you can also get some information from any membership that you're part of. For example, the AAPI, on their website they'll have information. You can always call if you have any questions and get some information that way. So I think there are, there is information out there. I think putting, you know, sticking your head in the sand and thinking it won't happen to me, I hope it doesn't happen to me, is not always, um... might actually heighten that anxiety I suppose. So I

[00:44:23] Bronwyn: yeah, we know that. Yeah.

[00:44:25] Caroline: Yeah, but there is information out there and there are a few videos as well I think AHPRA

[00:44:31] Bronwyn: I haven't watched them myself, but, but I'm sure they're fine. Yeah. Um, uh, there's one thing I wanted to add, like, because I see a lot of early career psychs are now going into private practice quite early. Um, so they'll be registered on, like a... this is anecdotal. Um, but I just wanted to say to listeners, like, please make sure you get regular supervision. I'm talking weekly. Um, so like put that in your financial considerations, um, because I think just as an early career psych, um, we've only had a few placements. Um, we may have had a previous career, say as a counsellor, um, but we haven't had a career fully fledged as a psychologist.

[00:45:07] And I feel like we are, um,

[00:45:16] Caroline: absolutely, I definitely second that. I think that's absolutely crucial and if you happen to work in a place where maybe there's group supervision that they do, I mean that that would be great, but at least if you don't have access to that. To ensure that, yeah, I think weekly is a really good frequency when you're starting out.

[00:45:32]

[00:45:37] Caroline: I think the biggest takeaway is to, you know, we entered this, this profession to continue that improvement, kind of improving people's lives, but also self improvement. And it is to look at this as, with that growth mindset, that It's just kind of, it's something to self improve, it might be a little hiccup along the way, um, but to learn from this process and just see that there's always that, yeah, that, I guess that opportunity for growth, and self improvement.

[00:46:10] Bronwyn: No, wonderful. That's a very hopeful ending. Thank you so much for sharing with listeners your knowledge around this process. I know I found it really informative and helpful to hear about it. And yet particularly like the idea that practitioners, they can experience this and still come out the other side, because I think like a lot of early career psychs are like, okay, I'll get a notification my career's over.

[00:46:31] So it's really helpful to hear from you and experienced supervisor in this area that no, that's not the case.

[00:46:37] Caroline: Absolutely.

[00:46:38] Bronwyn: Yeah. Um, so Carol, if listeners want to learn more about you or get in touch, where can they find you?

[00:46:45] Caroline: Absolutely. So you can find information about me on my website. So that's at psychorium.com. Um, I can send a link.

[00:46:53] Bronwyn: Yeah. I'll put the link in the show notes and it's, I didn't know it was pronounced psychothorium or I don't even know how to pronounce it. I read it as psychthurium.

[00:47:01] Caroline: No, it's psychorium. So it's yeah. Yes. I

[00:47:05] Bronwyn: that in the show notes and yeah, listeners, feel free to get in touch with Carol. She's a forensic psychologist who's very experienced and um, yeah, do you, you, are you taking on supervisees?

[00:47:16] Caroline: I am. So I'm open to, I love, I love supervision. I

[00:47:19] Bronwyn: Oh, fantastic. Yeah. No, such a pleasure. Well, thank you so much, Carol, for coming on once again.

[00:47:25] And thank you listeners for listening. I really appreciate your time and I hope this has been helpful for you and you can get on Come away from this episode with just a wee bit less anxiety. If you've enjoyed this episode or any one of our previous ones, do leave us a five star rating or review. It really does help us with like ratings and making sure that people get the podcast in their ears. Thank you. And that's a wrap.

[00:47:47] Thanks for listening to Mental Work. Have a good one and catch you next time. Bye.