Reflections on 2024 and intentions for 2025

The Business of Psychology

Reflections on 2024 and intentions for 2025

Welcome to the Business of Psychology podcast. This is the last episode in this series which means that it must be very nearly Christmas. So Merry Christmas everybody! I hope that you're easing your way into the festive period this year.

This is an episode that I actually planned for last year and I chickened out of posting. When it got to January, and it was too late to post it, I did a bit of reflection on why I hadn't aired the episode that I recorded this time last year, and I realised that I wasn't living my values in the best possible way. The reason that I hadn't posted it was that I was worried that some of the stuff in the episode wouldn't be liked by everybody, that it might be controversial to some people in some ways. and ultimately, I just wasn't in a place to be particularly courageous about that. Actually, when I look back on what a year I'd had in 2023, I can completely see why I didn't want to open the door for any hostility, potentially, or any controversy at all. It makes sense. I'd had a really tough year, and although this year has also been challenging, it hasn't been as emotionally demanding as last year, and I do feel in a position now where I actually really want to engage in debates, especially professional debate around the stuff that matters to me. So what I thought we'd do in this episode is think a bit about the stuff that's going on in mental health, particularly in the UK, but globally as well, and what that might mean for us, and questions that it's planted in my mind about where we might go as a group of professionals. I'm sure you won't agree with everything that I think, and that isn't the point, the point here is just that I think we need to engage with this stuff more, and I think that we need to be less concerned about agreement, and more concerned with professional and intellectual curiosity.

I've been really enjoying this year; doing a lot more collaboration with colleagues, getting into research again. And I think it's ignited in me this desire to really interrogate some of the assumptions that we make in our work, so I wanted to talk about that. And I thought I'd also reflect a little bit on what's been going on in my life and my business over the past year and how those two things might interweave with each other and maybe set some intentions going forward for 2025 because I think that's really important for all of us to be doing right now.

Full show notes for this episode are available at The Business of Psychology

Links/references:

Episode 151: The Immune Mind - Books that make you think

Episode 153: AI and the future of mental health with Dr Rachael Skews

Episode 149: Selling mental health services to organisations with Jessica Lorimer

Episode 133: An invitation to pause and reflect before 2024

Rosie on Instagram:

@rosiegilderthorp

@thepregnancypsychologist

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Shownotes

The mind-body connection

The first thing, which you'll have heard me talk about this series when I reviewed the book The Immune Mind by Dr Monty Lyman, is that the mind-body connection is getting better understood. I think many of us have been very interested in it for a long time, but there wasn't anything in my training, really, on the mechanisms by which the body and mind might interweave and I think that the research that's coming out about links between the gut and inflammation and loads of other biological factors that really put the bio in the biopsychosocial model. I think it's really important and our formulations are going to need to adapt radically to not just pay lip service to the role of biology, but actually start thinking about how we might interact with it, and potentially how we have to work with colleagues in order to provide effective treatment for people who are struggling in a particular way.

One example of that is in my specialist area of hyperemesis gravidarum there's been research published this year around the genetic component that might predispose somebody to struggling with hyperemesis. This is really powerful and you might think as a psychologist how is that going to affect the way you work with people, but it absolutely is because a lot of the time, a lot of what we're working with is a huge amount of self-blame and negative beliefs about the self because of struggling with such a debilitating illness during pregnancy, and this has big ramifications for that. Whether somebody is tested or not might have a big impact on their psychology. Another reason it's really important is that if we understand the gene, we might be able to understand treatments that could work in a preventative capacity. We might be able to put treatment programs in place for people before they become debilitated. And that's just not the way that it's worked historically, and it certainly isn't where psychology is placed in the pipeline. So, in order to make sure that our work is as effective as possible, we need to be able to understand the gene, what the geneticists and the medics are communicating around these changes, and I don't feel that well equipped to do that. I've got a real interest in it, and I've absorbed quite a lot of stuff, but I don't know the right terminology. The acronyms are boggling my mind. And I think that might need to change in our training, and I can't think of a specialty that this doesn't touch. If you've read The Immune Mind, or listened to my review of it, then you'll see that that book alone touches on almost every clinical specialty that I could think of. But other books I'm reading too, like Ultra Processed People by Dr Chris Van Tulleken, that's all about how lifestyle and diet is likely to be impacting on mental health and neurodivergence. It feels like every book I'm reading that is about physical health is also telling me something that I didn't previously understand or want to do more investigation into related to mental health or neurodivergence. So, I think this is a wave that we need to ride and we really need to up our understanding and our ability to communicate and liaise with other professionals, especially in our independent practices where we don't automatically have access to those professions. So, I've been looking a lot at MDT working with gynaecology and endocrinology, which I wouldn't really have been considering before. And I'm very interested in looking at how I might be able to work alongside people that understand the gut and the microbiome far better than I do as well. So, loads of interesting stuff, and I don't feel like we're there yet. I don't think we've got the understanding that we need, but this is something I think we really must pay attention to as professionals to make sure we're giving the best care that is evidence based, because actually the evidence is starting to tell us that the bio part is really important.

The AI revolution

If you listened to the episode with Dr Rachel Skews, I think you'll understand why I feel that this is going to fundamentally change how we work. I don't think it's going to do that within the next two or three years, but I do think in ten years, our practices will look quite different, and I think that could be really positive. I think there's loads of ways in which AI can allow us to provide more effective therapy, more effective consultation, more effective formulation. I'm really excited about the ability of AI to accelerate our work and our capabilities. But I also think that there's a role for us to play in the regulation of AI and in thinking through some of the difficulties that could arise if this train is allowed to just speed on down its track without any thought. So, I'm excited about it, but I also am a little bit nervous. I guess my message going into 2025 for myself and for anybody in independent practice is to be open minded and allow yourself to think creatively about how you provide the best service for your clients. I think it's been a bit of a theme of this series thinking about how we add that value and really allowing yourself to imagine how the tools that are being developed now can allow you to add more value and then being confident about that. I think if we have an existential crisis and start to think we're being replaced by AI, then we might be. But if we can take leadership and think carefully about how AI might enhance our expertise, I think we could actually take an important role in the development of AI and how mental health services shape around it. I've been writing a little bit about it recently, and I hope that what you'll take from this is excitement and enthusiasm and a desire to investigate what this might look like for your working life going forward over the next 5, 10, 15 years, because I think it is exciting.

The debates around neurodiversity and gender identity

Something I have been less happy about this year, and I do think is really difficult to talk about, but hopefully I'm not going to say anything radically controversial here, are two big debates that I see kicking off, frankly, in our professional groups. And that is the debate around neurodiversity and the labels, particularly, that we use, and the debate around gender identity. To be honest, I am quite ashamed of how toxic conversation on those subjects becomes and how quickly it descends into name calling and really oversimplification of the issues. I think we need to give ourselves a bit of a shake and remember that both of these subjects are going to be incredibly complex and there are going to be competing interests that are valid on all sides. So, we need to be able to cope with discomfort and disagreement and just respectfully consider alternate views that might have to sort of rub alongside each other. I think there's a drive, probably coming from a well-intentioned place, for this resolution where everybody agrees and everybody thinks, ‘oh yeah, you're right, I agree with you, I like you’. And actually, that might not be possible, because the number of stakeholder groups that have a legitimate stake in both of these big, big questions is just too wide. And so, there are always going to be people disagreeing. But I think it's frightening that we, as mental health professionals, are unable to talk to each other politely and compassionately and respectfully about these subjects. This is something I was worried about saying, because I don't want anybody to feel judged or shamed or that I'm criticizing a person here. I'm not. This is baked into the way that we've been trained. I remember this from day one of clinical psychology training. I remember it from when we did the psychotherapy week at the Tavistock. I really think that being very judgmental and critical of our peers is part of the way that we train our mental health professionals, and I think we have to change it. Part of that is around giving people the confidence to disagree and say it's okay to disagree, and we might get heated, and we might be passionate, but we are never going to accuse each other of not having the best intentions for the client in mind. What I see, is that everybody is coming from a well-intentioned place, they just think differently, and that should be okay. It's something that we do clinically all the time. Anyone that's done any consultation, families work, systems work, we're all really good at this when we're called to do it in those settings, but when we're left to our own devices, we seem to get into these really painful and quite vicious judgement loops, which I just don't think are advancing us at all.

I am by no means an expert in the neurodiversity debate, but I do have a personal stake in it. I've got children that have the labels autistic, ADHD, PDA, I've talked about that before. People are always trying to label me with various things as well. And so I feel that I am a stakeholder in that debate and I think I've got a couple of different perspectives based on different stakes that I hold and what that has made me think of is the need for a large scale needs assessment where we really investigate what does the language we use around neurodiversity need to do for all of the impacted stakeholder groups? What functions do those labels need to serve for people? And I wonder if we could then cross reference that with what the evidence is telling us, the evidence that we do have around origins, developmental trajectories, and all of that good stuff that you, listening to this, are probably more expert in than I am. Could we cross reference those two things and maybe as a collection of professional bodies, come together and come up with a system that is better than what we have in the DSM5 for giving people labels which work for them, which enable us to develop services that give people what they need. It all starts with the language, I think, and maybe we need to take a leadership role in developing the right language which is going to imperfectly meet the needs of the most people possible. Because what we have at the moment is just these little incremental tweaks to a system which is fundamentally flawed because it wasn't right to start with. Because nothing is right, you know, we're always just using our best thinking at that moment. And now we know that that best thinking, from whenever it was, like the 30s or 40s, wasn't really that helpful. So why we're just adding little tweaks to it year after year and then wondering why everything is broken, I'm not sure. It feels like there's enough people with skin in the game that maybe we could all come together and do something really large scale. And at least the system, although it still wouldn't be perfect, would, in some ways, come from a place of thought and compassion and research, and an attempt, a genuine attempt to meet the needs of all the stakeholder groups rather than just a few people having a conversation in a room. So that's my view. I don't really want to see any more debate articles from psychologists (in particular) about labels until that's happened. Until all the stakeholders’ voices are present in the debate, I don't really want to hear people pontificating about it because that just feels a bit unhelpful. I guess I'm a believer in nothing about us without us.

The gender identity debate, I don't pretend to understand fully at all, but I think a similar approach, where we accept that everybody's coming from a good place, but with really diverse experiences has got to be helpful. And I just really encourage the people with the expertise in that area to think about how, if there is a way that we could bring voices together, in order to have some sort of systematic approach to sorting this out. Because the toxicity of it has just got to stop, because it's dividing us as a profession, but it's also sending out really painful messages to the public, which I think are seriously detrimental. Maybe in 2025 we could start working towards something really positive that might have big benefits for the next generations.

My life and business

It feels really heavy to transition from that into thinking about my life. It seems a bit ridiculous, frankly, but I think possibly these things have informed or been in relationship with the changes that I've had in my life and that I've made to the business this year. I think it's always really useful to sit back and reflect on why you might have done some of the things that you've done this year, not done some of the things that you said you were going to do, and think about what is a good priority for you to take into 2025. So, in that spirit, I think that this year, I've had to adapt to a really radical new level of flexibility in my business. As you know if you've listened for a while, my business was always set up around the need to be flexible, around the needs of my kids. But over the past year, for about the past nine months, those needs have changed in a way that means that I've had to reduce my working hours. I'm only really working a day and a half a week now. I do squeeze in hours here and there where I can grab some, but I can only guarantee a day and a half. All of my delivery time, where I'm actually talking to coaching clients, talking to therapy clients, or delivering for organisations, that all has to be done within that time. Everything else I might try and fit into kind of two hours here or an hour there, but that stuff has to be very firmly bracketed into the limited amount of safe time where I know that I have childcare. That meant that I had to really focus on what do I need from this business? And of course, there's always two sides to that question. There's what do we need financially and there's also what do I need to feel fulfilled and to feel that I've still got myself, a part of myself, in the midst of what is a very challenging emotional time to be a parent. So, I realised that something I needed to get closer to and do more of this year was collaboration with colleagues and research, because I'm really passionate about independent practice giving us this ability to innovate and bring the latest evidence based practice to our clients and much more quickly than we can do if we're working in a very busy NHS service, for example, where you have to get the green tick before you can do things, but also where it's very difficult to spend a lot of time reading and going to conferences and doing your own research because the...