Interventions Topic 3 Part 1 The Effective Practitioner

Summary

In this session on forensic mental health, Elie Perer highlights the importance of self-reflective practice for practitioners. The lecture shifts focus from clients to the self-care and professional health of practitioners, exploring the necessity of self-awareness and self-reflection in providing effective therapy. The challenges facing mental health practitioners, including barriers to empathy, support, and authenticity in relationships with clients, are discussed. Emphasis is placed on self-care as an ethical imperative to prevent burnout and ensure professional competence.

Highlights

• The lecture stresses the importance of practitioners focusing on self-care to prevent burnout 🌼
• Forensic mental health practitioners must balance personal and professional life for effective practice ⚖️
• The session discusses the high risk of suicide among healthcare professionals and the role of self-care in prevention 💔
• Participants are encouraged to seek professional support and supervision to manage distress 😇
• Self-awareness, self-assessment, and self-reflection are keys to sustaining a healthy practice 🔑

Key Takeaways

• Self-care is not a luxury but an ethical imperative for mental health practitioners 🌟
• Practitioners must be aware of their own biases and manage them effectively to provide quality care 🌈
• Professional isolation can contribute to distress; peer support and supervision are vital 💪
• The emotional demands of the job require practitioners to seek professional help early to avoid burnout 🚑
• Practitioners are encouraged to reflect on their strong emotions towards clients to manage them appropriately 🤔

Overview

The lecture delivered by Elie Perer sets the stage for a thoughtful reflection on the role of self-care in the forensic mental health field. Moving beyond client care, the focus shifts to practitioners themselves, challenging them to embrace self-reflective practices that ensure their well-being and professional efficacy. It highlights how self-awareness and personal reflection can mitigate the risk of burnout and counteract the distress often experienced in such demanding roles.

With a candid discussion on the barriers faced by mental health practitioners, Elie addresses the intersection of personal biases and professional practice. The lecture explores various professional challenges, emphasizing the ethical necessity of self-care as not just beneficial but crucial for sustainable practice. The conversation underscores the critical need for practitioners to understand and manage their emotions and biases to maintain high-quality client care.

The session also brings to light the alarming statistics regarding burnout and mental health issues within the professional community, particularly among nurses and physicians. Elie advocates for proactive measures like peer support, personal psychotherapy, and ongoing professional development. The takeaway message is clear: Practitioners must prioritize their self-care, integrating reflection and assessment into their routine to thrive both personally and professionally.

Chapters

• 00:00 - 00:30: Acknowledgement of Traditional Owners and Course Introduction The chapter begins with Elie Perer, the course instructor, welcoming students back to the course on Interventions and Recovery in Forensic Mental Health. He announces the transition to topic three, which focuses on self-reflective practice.
• 00:30 - 01:00: The Role of Practitioners in Forensic Mental Health The chapter discusses the interchangeable use of the terms 'therapist' and 'practitioner' within the context of forensic mental health in Australia. It highlights that 'practitioner' is a broader term that applies to various professionals working in the field. The content of the lectures can be applied across different areas, including health and mental health, indicating the relevance of the discussions for a wide range of professionals.
• 01:00 - 01:30: Focus on Practitioners and Self-Reflection The chapter titled 'Focus on Practitioners and Self-Reflection' explores the shift of focus from clients to practitioners, emphasizing the importance of self-awareness and self-reflection in being effective practitioners. The discussion includes managing countertransference and provides an example of a reflective process. It concludes with a simple exercise in reflective practice, recognizing the diverse backgrounds of practitioners.
• 01:30 - 02:00: Discussion of Psychological Treatments and Therapy The chapter focuses on psychological treatments and therapy in forensic mental health. It follows discussions on the nature of forensic mental health, the professionals involved, client pathways, and previous talks on biological interventions. The emphasis is now shifting to psychological therapies as a key component of treatment in forensic settings.
• 02:00 - 03:00: Building Effective Practitioner-Client Relationships The chapter "Building Effective Practitioner-Client Relationships" discusses the importance of interaction in psychotherapy. It elaborates on how practitioners can work with clients' thoughts and emotions, emphasizing the practitioner's motivation towards fostering positive change. Regardless of experience level, practitioners are guided on applying these principles to improve mental health.
• 03:00 - 04:00: Barriers to Practitioner Empathy and Support The chapter titled 'Barriers to Practitioner Empathy and Support' discusses the interchangeable use of the terms 'practitioner' and 'therapist,' emphasizing that 'practitioner' is a broader term covering a wide range of professional experiences. The introduction sets the stage for the course discussions by highlighting the importance of applying the content to professional mental health interactions and beyond. It prompts the listeners to consider what constitutes effective therapy as the starting point for exploring the barriers practitioners face in delivering empathetic support.
• 04:00 - 05:00: Challenges and Self-Care for Practitioners The chapter titled 'Challenges and Self-Care for Practitioners' discusses the complexities and crucial elements that define the interactions between practitioners and their clients. It emphasizes the importance of recognizing the environment and systems influencing both clients and practitioners, which include the physical environment, like high-security hospitals, and relational dynamics, such as those between clients and their families or caregivers. Understanding these components is essential for practitioners to perform their roles effectively and maintain their well-being.
• 05:00 - 06:00: Statistics on Mental Health Challenges in Healthcare Professionals The chapter discusses the importance of the practitioner's interpersonal characteristics and style in establishing a positive relationship with clients. This relationship, termed as a 'positive alliance,' is crucial for engaging with clients effectively and facilitating change. The text implies that the emotional and professional interaction matrix between healthcare professionals and their clients plays a significant role in mental health settings.
• 06:00 - 08:00: Importance of Self-Awareness and Addressing Notifiable Behaviors The chapter discusses the importance of self-awareness in recognizing and addressing maladaptive schemas that affect personal psychology. It highlights the role of mental health practitioners in helping clients understand how these schemas influence their relationships and self-perception. This understanding is pivotal in shaping expectations and improving interpersonal relations.
• 08:00 - 10:00: Self-Care as an Ethical Imperative The chapter discusses the importance of self-care for practitioners as an ethical mandate. It emphasizes the need for practitioners to enhance their self-awareness, particularly regarding personal biases. Practitioners should learn to manage or bracket these biases during assessment or treatment of clients, regardless of whether they can effect lasting change. The idea of self-care is positioned as essential for ethical practice in the therapeutic context.
• 10:00 - 11:30: Identifying Emotional Responses and Practitioner Challenges The chapter discusses the cartoon portrayal highlighting the significance of therapeutic interaction. It emphasizes the multifaceted role of therapists, stressing the necessity for empathy, supportiveness, non-judgmental attitudes, authenticity, and direction. Practitioners are encouraged to be attentive, engaged, committed, and intellectually and intuitively present. This comprehensive presentness is portrayed as essential for helping clients undergo therapeutic change, illustrating the substantial effort required in the therapeutic practice.
• 11:30 - 12:30: Conclusion and Invitation to Reflect The chapter concludes with a reflection exercise for the reader. After presenting certain characteristics, the speaker invites the reader to take a moment to consider personal barriers to being empathic with clients. The purpose is to encourage self-exploration and to identify challenges that may inhibit empathic interactions.

Interventions Topic 3 Part 1 The Effective Practitioner Transcription

• 00:00 - 00:30 welcome back to interventions and Recovery in forensic mental health my name is Elie perer and I'm teaching this course this trimester so now we're getting ready to head into topic three which is self-reflective practice so before I start these many lectures go out across Australia and therefore I'd like to acknowledge the traditional owners of all the lands throughout Australia I'd like to acknowledge that Elders of these lands the elders that are past and the elders that are present today and I hope that any of the material that present within the course
• 00:30 - 01:00 is sensitive to the hardship suffered by people across Australia so as we go through the mini lectures you're going to hear me use the term therapist and practitioner interchangeably so consider practitioner as a broader term for professionals who work in the field the content in these mini lectures can be applied to any part of the field where we work uh whether that's in health mental health um so with anyone but in as considered a
• 01:00 - 01:30 forensic mental health client so today we're going to have a look at you as practitioner so we're changing our Focus from clients to practitioners for this topic uh we're going to talk about what we need in order to be effective practitioners talk about self-awareness and the importance of self-reflection going to take you through an example reflective process talk about managing counter transference and then finish up with a simple exercise in reflective practice so we all come from a variety
• 01:30 - 02:00 of professions working backgrounds and experiences of mental working in mental health and specifically working in forensic mental health so we've discussed so far in the trimester what forensic mental health is um and the clients within their individual Pathways settings and we've also spoken about biological interventions we're now moving into discussion of psychological treatments within forensic mental health so psychologic to which is a therapeutic
• 02:00 - 02:30 interaction focusing on working with a person's thoughts emotions and the interaction between these and the person's environment in order to improve their mental health so an example of this being Psychotherapy so the basic Foundation under this is the interaction between um the practitioner and the client where the practitioner is motivated towards um positive change for the client so no matter your experience or level of understanding you can apply
• 02:30 - 03:00 what we cover here today to your professional interactions in mental health and Beyond so throughout this um set of mini lectures you can substitute the term practitioner for therapist um I'll be using them interchangeably as practitioner as I mentioned is a broader term uh that would cover more of the experience base amongst us um undertaking this course this trimester so let's start by having a look at what is effective therapy
• 03:00 - 03:30 so this is kind of my own visual understanding of the key components of our relationship between clients so the sum of the parts being more than the whole so something we already know about how to be effective in our roles so consider the environment the systems within which the clients the physical environment so for example High secure security Hospital the relational system so example between their uh parent their
• 03:30 - 04:00 partner um are they an involuntary patient then the practitioners interpersonal characteristics and interpersonal style in combination with the client's perceptions the practitioner play a really important role in establishing a positive Alliance or relationship with a client it's through this relationship that we we're able to engage with an effect change in people so within this consider the relational Matrix of the interaction of
• 04:00 - 04:30 a practitioners and clients Mal adapto schema So based on the assumption that we all have Mal adapto schemas so these schemas affect the way you relate to other people they shape the way you think about yourself shape the way you think about other people they shape your expectations so as mental health practitioners we provide clients with an understanding of why and how they affect their own psychology we help them understand them understand themselves um today the focus
• 04:30 - 05:00 is um on us as practitioners and looking at enhancing our understanding of ourselves becoming more aware of our biases and being able to bracket these or manage them when we're assessing or treating other people so we need to be able to deactivate or manage schema in ourselves and clients even if we don't bring around uh lasting change so a bit of a funny
• 05:00 - 05:30 cartoon about the importance of therapeutic interaction so our role as a therapist or practitioner is to be empathic supportive non-judgmental authentic directive attentive engaged committed present in a present intellectually intuitively verbally non-verbally and open to helping clients therapeutically change so a lot of work okay so a lot of work is involved in just being present
• 05:30 - 06:00 and presenting with these characteristics so now I'd like you to grab that pen and paper that I spoke about earlier and write down your responses to the following so what are some of the barriers to you being the following with clients empathic so what are some of the barriers to you being empath paic
• 06:00 - 06:30 particularly with forensic mental health clients what are some barriers to you being supportive barriers to being non-judgmental what about barriers to you being authentic in the therap itic
• 06:30 - 07:00 relationship and lastly directive so what are some of the barriers to you being directive in a therapeutic relationship so the barriers that sit with the practitioner specifically are often multi-dimensional in that they include one or more of the following at any one time so personal characteristics and schema so um those of you who are
• 07:00 - 07:30 mental health professionals may have been more likely to be attracted to this profession because it allows us to continue as caregivers and because it also possibly allows us to work to address or resolve earlier patterns of difficulty or dysfunction common challenges so no we're no less likely than the average person to experience effects of daily stresses or physical or mental health concerns including substance use disorder disorders the nature of the
• 07:30 - 08:00 work so this places us at risk of distress and impairment emotional demands of clients clients with chronic difficulties suicidal clients violent clients for some people professional isolation so if you're working in private practice um and then also requirements of responding to people's crises um it can be practitioners lack of skill and knowledge which is what we think about most we often think about the biggest barrier to us affecting change in someone else is oh know I need to upskill I need to do the next degree
• 08:00 - 08:30 I need to do the next Workshop um but what about self-care so we're trained to attend to other people's emotional states and difficulties but run the risk of being professionally blind to ourselves and our needs and concerns so some confronting facts so we see elevated suicide rates of in Health Care Professionals in comparison to the general population
• 08:30 - 09:00 most epidemiological studies in healthcare we're seeing issues with Physicians and nurses key factors um associated with this um elevated suicide rate particularly in Physicians and nurses um we have high access to means um and we also got the stigma of addressing mental health um and stress we have burnout as a a huge contributing factor ice are emotional exhaustion
• 09:00 - 09:30 depersonalization feeling of low personal accomplishment a national study of suicide in Australia where we were able to look at gender and professional groups together we have male nurses and midwives with the highest rate of suicide followed by men in non-health care positions then men in medical professionals um female nurses and midwives then down from that Fe medical professionals than females in other
• 09:30 - 10:00 non-health care positions so the rate of suicide amongst women employed in any health profession uh was higher than women in other occupations the difference was statistically significant for women employed as nurses or medical practitioners so compared with that of men in other occupations the suicide rate was higher only amongst male health professionals in the field of Nursing and Midwifery so further the rate of su side was 62% higher amongst health
• 10:00 - 10:30 professionals with ready access to prescription medicines than amongst health professionals without such access and that's talking to the means a survey of psychologists as a reflection of therapists as a larger group so more confronting facts 60% had been significantly depressed some time in their career 29% had felt suicidal and 4% had ATT attempted suicide 97%
• 10:30 - 11:00 live with the fear of a client committing suicide and more than 50% reported that their concerns about their clients negatively impacted on their personal functioning so their sleep diet concentration and focus um the APA Wellness survey um identifi that 60% um of practitioners at least Had A disruption to professional functioning due to burnout anxiety or depression so it's not just doctors and nurses and
• 11:00 - 11:30 psychologists we have stats on the suicide rates of doctors and nurses we know there are risks for other health professionals we know staff are impacted personally by clients we have professionals anonymously admitting to being distressed um that it adversely affects the assessment and treatment of clients but they keep working we have studies that identify common risk factors in those professionals who have attempted or completed suicide so these factors are work-related stress burnout
• 11:30 - 12:00 depression alcohol and drug use negative life events and or isolation so whether it's physical or personal isolation we also have Ironically in our field of mental health the issue of problems with help seeking so considering a profession um us feeling reluctant to seek help from colleagues or other professionals if we Face issues with our own mental health we educate others about the the negative effect of stigma associated with mental health but
• 12:00 - 12:30 maybe because of this stigma or the effect that disclosure may have upon work whether real or perceived a lot of people choose not to seek help so it's not that distress automatically means a practitioner's professional competence is impaired but if it's left untreated over time it can negatively impact their competence can lead to or be a result of vicarious trauma and or practitioner distress also
• 12:30 - 13:00 can lead to burnout or terminal phase of a practitioner distress so burnout being characterized like as I mentioned before by depersonalization emotional exhaustion and a lack of feelings of satisfaction and accomplishment and it may be result from prolonged work with emotionally challenging clients this can in turn result in a use of maladaptive coping strategies like drugs and alcohol so we need to be self-aware know when a professional competence is impaired and
• 13:00 - 13:30 protect both our clients the community and ourselves so we have to consider notifiable behaviors that we might see in the extreme when these personal barriers to effective practice aren't addressed so in yourself and colleagues examples of behaviors um that are notifiable by law for health practitioners registered under national law um employers of practitioners and education providers so these are the things that you need to report if
• 13:30 - 14:00 someone's practicing while intoxicated by alcohol or drugs engaging in sexual misconduct in connection with the practice of the practitioner's profession or placing the public at risk of substantial harm in the practitioner's practice of the profession because the practitioner has an impairment placing the public at risk of harm because the practitioner has practiced the profession in a way that constitutes a significant departure from accepted Professional Standards so please refer to your own individual
• 14:00 - 14:30 professions or workplace code of conduct and national law but ultimately at the end of this we need to know that self-care is an ethical imperative so we have the extreme end of the Continuum how does it actually get this bad so how does it get to this we tend not to confront distressed colleagues they could be managers direct line supervisors have standing in the
• 14:30 - 15:00 workplace we're not comfortable seeking assistance and we can lack self-awareness what else what brings us to and I guess that brings us to our Focus today so how do we stop at getting to that point I'm putting a to you today that as an individual and as a colleague that no matter the section of the field that you're working in or plan to work in
• 15:00 - 15:30 that we can work together to stop getting it to this point so looking for self-care self- assessment and self-reflection so self-care self- assessment self-reflect so being self-aware so be self-aware of when ATT tend to personal risk factors and warning signs know the client groups that you can work with and the ones that you can't work with effectively identify presence of increased challenges or stresses in your life so whether that's health or mental health difficulties
• 15:30 - 16:00 note strong reactions to the workplace um avoid negative coping strategies and utilize professional supports so what can we do so we can start by seeking out professional support so do it early let's be preventative let's look for peer support have regular supervision whether it's individual and group internal to your service external to your service undergo personal Psychotherapy participate in
• 16:00 - 16:30 professional associations undertake professional development and networking opportunities like you're all doing as part of this course support the establishment of open sharing peer supportive and consultative workplaces which can be a challenge but achievable okay start the process towards finding a balance between personal and professional so so this is a a bit where I'm a little bit like a
• 16:30 - 17:00 fraud at the beginning of the process so work life balance is always really good to have seek diversity in professional activities and case loads take a break or two rest and exercise attend to mind body relationships and soul but something I'm wholeheart that I wholeheartedly believe in is that as as caregivers as mental health professionals we almost have to give ourselves permission so these aren't luxuries they're an
• 17:00 - 17:30 ethical imperative so self-care is not a luxury but an ethical imperative so where do we start so today we're going to start with self-reflection so consider this cartoon so if you're feeling like this you need to reflect on why so identifying strong emotions and responses to clients and manage them appropriately so this is a clinician checklist it's an but a goodie so are
• 17:30 - 18:00 you experiencing any of these so an increasing distaste for patient client over emotional regarding patient troubles excessive fondness sleepiness in the presence of a client frequent lateness frequent intense arguments um is a person appearing in dreams um are you thinking about premature termination so you're thinking okay how can I just get rid of this CLI of my books uh is there undue pessimism or optimism what about derogatory criticism in like when you're even in supervision or when
• 18:00 - 18:30 you're thinking about the client is there affective withdrawal so you're emotionally withdrawn from the process regressive to Orthodoxy are you being really conservative and black and white in your process are you experiencing feelings of inadequacy in relation to your work with the client so thinking about there're just a couple of things to think about as we go through so now take some time to go on the next mini lecture we're going to talk about self-awareness and self self-reflection