Episode 1a: The value of the Therapeutic Alliance

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In this episode, I talk to Dr Alice Nicholls about the therapeutic alliance and how to cultivate a productive relationship with our clients.

Keywords:

psychology, case manager, solicitor, therapist, care team, therapy team, legal team, working relationship, therapeutic alliance, rapport, emotional bond, client-centred, person-centred, counselling, unconditional positive regard, recruitment, support worker, litigation, problem-solving, paralysis, listening, validation, connecting, pain, upset, suffering, needs, trauma, safety, containment, manipulation, communication, safety, honesty, professionalism, goals, values, collaboration, help, compassion, cultural or religious factors, openness, respect, boundaries, relatable, checking, connection, rupture and repair, at-risk behaviours, sustainability.

2:57 What is the therapeutic alliance?

6:39 A metaphoric exercise

9:58 Overcoming paralysis in a case

11:53 The impact of trauma

14:13 Feelings of manipulation when emotions are high

16:59 Bringing your professional needs to the table

18:47 Being values led and transparent

20:03 Framing your work as ‘help’

21:19 Religious and cultural factors

22:21 Being more approachable

23:28 Remaining boundaried and professional

26:03 Better outcomes for your client

27:47 The therapeutic alliance as a work in progress

28:58 Practical tips to improve your therapeutic alliance

31:43 Asking the questions even when things are going well

32:43 When it all goes wrong - rupture and repair

35:33 An example from Shabnam’s experience

37:55 The benefits to your work - sustainability

Guest: Dr Alice Nicholls

Presenter: Dr Shabnam Berry-Khan, Director of PsychWorks Associates

Editor: Emily Crosby Media

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Episode 1b: Managing stress for clients and ourselves

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Dr Alice Nicholls returns to discuss stress, its symptoms and triggers, and what we can do to mitigate it.

Keywords:

stress, personal injury, clients, fight, flight or freeze, threat, survival, control, stressors, capacity, case management, signs and symptoms, supervision, communication, triggers, sleep, coping strategies, breathing, avoidance, self-care, kindness, replenishing, glorifying being busy, perfectionism, good enough, outsourcing, , expectations, compassion, acknowledgement, burnout

1:36 What is stress?

4:10 The effects of stress

6:09 The psychological theory of stress

8:54 Stopping our automatic responses

10:00 Burnout

12:45 Stress in Case Management

14:20 Recognising the signs and symptoms of stress

18:32 Recognising stress in ourselves

20:20 The importance of supervision

24:07 Triggers of stress

28:53 Coping strategies

31:08 Avoidance

33:00 Positive coping strategies

34:45 Avoiding punishing ourselves with self care

36:40 Admitting stress in Case Management

38:32 Neutralising triggers and accepting ‘good enough’

42:51 Focussing on what does work

43:55 Having high expectations

44:58 Self compassion

47:00 Mindfulness practices

Guest: Dr Alice Nicholls

Presenter: Dr Shabnam Berry-Khan, Director of PsychWorks Associates

Editor: Emily Crosby Media

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Episode 14: Returning to work

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Our BI clients might have had fulfilling and meaningful work lives before their injury and its loss can be a huge source of distress. Thinking about returning to work is a huge part of some clients' psychological and rehabilitation journey. This week, we have a special Guest: Suzanne, who is a rare combination of Occupational Psychologist and BI Case Manager! She helps us think about the process of preparing with a client for a return to meaningful occupation.

Keywords:

Change, transition, work, brain injury, occupational psychology, vocational rehabilitation, meaningful employment, guidance, employers, enrichment, occupation, hobbies, compensation, structure, volunteering, epilepsy, social life, communication, MDT, graded return to work, Access to Work, Equality Act, reasonable adjustments, litigation, loss of earnings.

2:50 What is an occupational psychologist?

3:32 What training do they receive?

6:13 How an occupational psychologist can help someone with brain injury

9:33 Factors of value for work

12:17 Voluntary work

14:33 Who can benefit from help to get back to work

17:22 What makes a client suitable for help

19:52 Returning to the same job

22:42 Supporting employers

24:13 Improving work environments for clients

25:20 Access to Work scheme

26:25 Realistic expectations

28:47 Reasonable adjustments

29:22 Employment and the litigation process

33:23 Advice for considering a return to work for your clients

35:33 When to call in a professional for help

Quotes:

13:45 "Work is really vital for somebody’s sense of identity, to just be able to contribute and have something to get up for."

19:45 "Has your client got a gap in their life that could be filled by work?"

23:08 I always say to employers: I don’t know the first thing about engineering, so why would an engineer know the first thing about brain injury?"

Guest: Suzanne Guest, Work in Mind

Presenter: Dr Shabnam Berry-Khan, Director of PsychWorks Associates

Editor: Emily Crosby Media

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Episode 2: How to work with challenging behaviours

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I’m joined once again by Dr Alice Nicholls to discuss the management of challenging behaviours.

Keywords:

brain injury, catastrophic injury, post-traumatic amnesia, confusion, recovery, complex, challenging behaviours, understanding, support, quality of life, risky behaviours, risk of harm, access to community, restriction, disruption, stress, frequency, intensity, swearing, family, care teams, multidisciplinary, aggression, anger, managing emotions, environment, training, framework, performance, expression, adjustment to injury, outlet, communication, unmet needs, reinforcement, misunderstanding, consistency, behavioural management, systemic, strategy, multiple perspectives, hypothesis, tentative, professional network, case managers, solicitors, collaboration, treating behaviours, practical steps, data collection, prevention, top tips

0:24 Challenging behaviours following brain injury

2:21 Introducing Dr Alice Nicholls

3:20 How do you define challenging behaviours?

5:06 Some examples of challenging behaviours

8:29 Why do challenging behaviours happen?

12:35 Consistency in behavioural management

14:17 Collaborating with the whole team from the beginning

17:00 Going forward with a working hypothesis on treating behaviours

18:58 Practical steps to take when meeting challenging behaviours

22:45 Data collection to aid prevention

26:11 Dr Alice’s top three tips

Quote: 26:49 "My top tip, or my take-home message, is that challenging behaviour is always meeting an unmet need."

Guest: Dr Alice Nicholls

Presenter: Dr Shabnam Berry-Khan, Director of PsychWorks Associates

Editor: Emily Crosby Media

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Episode 3: The role of trauma in injury work

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Today I’m joined by Dr Marianne Trent of Good Thinking Psychological Service, to talk about grief and trauma.

Keywords:

Psychologist, human, compassion-focused therapy, case managers, solicitors, personal injury, grief, trauma, threat, hopes and dreams, grieving, reptilian brain, mammalian brain, shame, fault, triggers, family, ecosystem, fragility, crying, tears, witness statements, assessment, litigation, re-traumatisation, rehabilitation, recovery, safety, containment, depression, support.

1:50 Marianne’s work and Compassion-Focused Therapy (CFT)

3:25 Specialising in personal injury work

5:00 A definition of trauma

8:00 The overlap between trauma and grief

9:08 A definition of grief - unfairness and loss

10:07 Safety and containment

10:48 Using CFT with traumatised clients

15:00 The effects of trauma on a whole family after an accident

16:58 Understanding the fragility of the family context

18:30 Tips for working with trauma - don’t be scared of tears

20:43 Avoiding re-traumatisation through the legal process

26:47 The Our Tricky Brain Kit

29:08 The Grief Collective book

Quote: 22:42 “I appreciate that there are lots of sad stories in offices all over the country, all over the world; but these are still real people’s lives, and real people need support. Real people need help.”

Guest: Dr Marianne Trent

Presenter: Dr Shabnam Berry-Khan, Director of PsychWorks Associates

Editor: Emily Crosby Media

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Episode 4: Why we all need to tame our inner critic

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My reflections as host to (a) a new podcast and (b) an established inner critic.

Keywords:

Reflections, podcast, mindset, inner critic, best life, treating psychology, case management, work/life balance, catastrophic personal injury, thrive, self-doubt, worry, childhood, emotional security, caring professions, sacrifice, criticism, doubting, berating, should, ought, must, shame, self-critical, self-worth, resilience, confidence, compassionate, therapy, value, relationships, replenishment, wobble, authentic, reflection, comfort, strength, confidence, space, balance, sustainability.

0:56 Inner critic

2:09 The purpose behind this podcast

3:54 Triggering your inner critic

5:15 Tracing the origin of your critical voice

7:00 How I have tamed my inner critic

7:41 Noticing the voice

9:58 Allowing yourself balance and fairness

11:10 Finding supporters

12:48 Positive statements

13:36 Thinking about how other people see you

16:11 Giving yourself space for balance

17:50 The benefits of taming that inner critic

Quotes: “I do believe that we need to be nourished in the journeys that we are taking with our clients.” “It’s ok to want to thrive in caring professions like the one we do. We don’t have to always sacrifice ourselves.”

Presenter: Dr Shabnam Berry-Khan, Director of PsychWorks Associates

Editor: Emily Crosby Media

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Episode 5: Top tips for managing care teams

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I speak to Dr Stavros Orfanos, PsychWorks Associates psychologist, about the lessons for case managers from his research into group processes.

Keywords:

care teams, medico-legal, interactions, group dynamics, group interactions, outcomes, therapy, group processes, engagement, participation, conflict, friction, anger, avoidance, personality, structure, medium, leader, characteristics, focus, client, case managers, behaviour, decision-making, monitoring, attention, care needs, supervision, commonalities, care package, team meetings, avoidance, reflective, being proactive, communication channels, reactive, healthy group environment.

3:12 Stavros’ research and PhD

5:01 What are group processes?

6:38 How do they apply to care teams?

8:40 How groups work

10:17 What do we lose by not thinking about group processes?

11:20 Practical ways to optimise your team

12:05 Ensuring engagement

13:51 Monitoring conflict

14:30 Identifying avoidance

15:11 Supervision as a reflective practice

16:02 Being proactive

21:03 What to do when groups break down

22:20 When to bring in help

Quotes: “What’s really important is that case managers pay attention and really monitor the interactions between group members... Be proactive about monitoring and identifying group processes... The most healthy groups in the end are ones who have gone through some conflict but are able to work through it.”

Guest: Dr Stavros Orfanos

Presenter: Dr Shabnam Berry-Khan, Director of PsychWorks Associates

Editor: Emily Crosby Media

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Episode 6: Compassion-Focussed Therapy

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Dr Alice Nicholls returns to tell me all about CFT and its relevance for personal injury work.

Keywords:

threat, clients, soothing, drive, compassionate, system, compassion, personal injury, oncology, compassion-focused therapy, CBT, CFT, shame, critical, evolutionary, motivational systems, cortisol, dopamine, oxytocin, threat-drive loop, burnout, trauma, critical internal voice, doing, being, kindness, sustainable, connecting, universality, human, suffering, balance.

1:20 How Dr Nicholls got into CFT

1:49 A history of CFT

3:15 The scientific basis of the model

9:40 The Threat-Drive Loop

12:20 The effects of an overly critical internal voice

13:04 How compassion helps

14:48 Breaking out of the loop

16:48 Ways to activate the soothing system

18:00 Using compassion in your life

19:05 Universality of CFT

21:43 The need for compassion in case management

23:50 The effect of staying stuck

25:10 Tips for personal injury professionals

• 25:36 Noticing

• 26:19 Soothing

• 27:10 Remembering kindness

28:13 Soothing doesn’t need to feel overwhelming

29:30 Framing experiences with CFT

31:02 Fight criticism with compassion

34:16 Generating compassion in difficult cases

35:25 Compassion doesn’t always come easily

Quotes:

18:26 “To be compassionate is to be wise, and to be strong, as well as to be kind.”

31:02 “People who are being critical are people who are in threat… and once you realise that, it’s much easier to be compassionate towards them.”

Guest: Dr Alice Nicholls

Presenter: Dr Shabnam Berry-Khan, Director of PsychWorks Associates

Editor: Emily Crosby Media

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Episode 7: Rehabilitating love

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I'm joined by Dr Giles Yeates of Rppling Minds to discuss an approach to the rehabilitation of brain injury survivors in the context of their intimate relationships. For links to resources mentioned in this episode, please see the transcript below.

Keywords:

couples therapy, relationships, brain injury, survivor, partner, heartbreak, disconnection, emotional, neurorehabilitation, attachment, emotion-focused therapy, EFT, counselling, stroke, communication, reconnection, vulnerability, withdrawal, confusion, personality change, divorce, separation, distress, rehabilitation, love, depression, Headway, Different Strokes, information, ripples.

01:47 How Dr Yeates got into this field

08:21 EFT couples training

11:16 Application with couples after brain injury

17:36 Common challenges for male survivors - confusion

20:04 Working on issues between people

23:47 Divorce

26:25 Rehabilitating love

33:37 Opening up the conversation

40:04 Putting yourself in their shoes

42:44 Summary

45:46 Rippling Minds

Quotes:

“Any approach to emotional change for a survivor of brain injury really needs to be in the moment and at a slow pace to really let things be processed and sink in.”

“You want your empathic husband or wife back who you had before the accident, but they may not come back to you without you opening the door, unlocking the lock yourself.”

“To see your partner being different can actually have a destabilizing effect on your sense of self.”

“We need to stop thinking about the change happening to a survivor’s brain, on its own. We need to think, actually what’s happening is a two-way process between people.”

“Dare we rehabilitate love after brain injury? Why not?”

Guest: Dr Giles Yeates, Rippling Minds

Presenter: Dr Shabnam Berry-Khan, Director of PsychWorks Associates

Editor: Emily Crosby Media

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Episode 8: Imposter syndrome

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This episode is an exploration of 'Imposter Syndrome' and the effects it can have for many people on their professional and personal lives. I reflect on personal experience and ways to move beyond perfectionism and self-doubt, towards more realistic, healthier expectations of ourselves.

Keywords:

imposter syndrome, self-doubt, discomfort, upbringing, achievement, confidence, perfectionist expert soloist natural genius, superhuman, incompetence, insecurity, perspective, calibrating, accomplishments, self-help, 6 out of 10, good enough, balance, mindset, productivity, self-worth.

05:00 Five personality types associated with imposter syndrome

10:02 The effect of imposter syndrome on personal injury professionals

11:23 Learning to feel comfortable in the discomfort

12:38 Talking to people you trust

13:31 Remind yourself of your accomplishments

14:16 Reframe your thinking

15:29 Good enough is good enough

18:20 Speaking your truth

Quotes:

“Research shows that imposter syndrome can be especially prolific in the helping professions.”

“The insecurity and doubt that you feel are in fact reflections that you are normal and human

There is no perfect method for this game called life.”

“If you’re always striving for 100%, you need to turn it down a notch or so.”

Presenter: Dr Shabnam Berry-Khan, Director of PsychWorks Associates

Editor: Emily Crosby Media

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Episode 9: Recruitment

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Today I'm speaking to Lara Crombie about many aspects of recruitment: finding a good fit, psychometric testing, unconscious bias, the recruitment process, CVs and interviews, job description and personal specifications, getting help with HR, some pitfalls to avoid, and ultimately how to do it really well.

Keywords:

recruitment, care package, rehab goals, carers, support workers, personal injury clients, case managers, deputies, families, niche, dynamics, litigation, care team, aptitude, attitude, fit, job description, person specification, adverts, flexible, humour, psychometrics, conversation, sustainable, intuition, interview, unconscious bias, screening, race, gender, social media, application form, timetable, paperwork, team management, offer letter, contract, liaison, onboarding, timely, partnership, Finders Keepers.

1:24 Guest intro

2:45 Why go to a niche recruiter

4:50 How they recruit

6:37 How to find ‘fit’

7:56 Psychometric testing

9:23 Unconscious bias on gender and race

13:47 The recruitment process

15:33 The best candidate isn’t always looking for a job

17:11 CVs

18:15 Interviews

21:45 How long does the process take?

23:35 Writing the job description and personal specification

26:00 Help with HR

29:40 The pitfalls of working with a recruitment team

31:16 What can personal injury professionals do to recruit smoothly?

• Tell your recruiter everything

• 33:11 Interview quickly

• 34:33 Help them to work with clients/families

35:45 Summary

38:57 Contact details

Quotes:

6:05 “It’s great to have specific experience in certain areas, but more often than not, it’s the attitude and aptitude of the person. That’s the most important thing, alongside the fit with the family.”

17:30 “Great carers don’t always have great CVs… or any kind of CV, in fact.”

28:59 “It’s not only about finding people for our clients. It’s ensuring that they’re going to stay.”

38:40 “Bear in mind that skills can be learned and people can be developed, but the attitude and aptitude has to be right.”

Guest: Lara Crombie, Finders Keepers Recruitment

Presenter: Dr Shabnam Berry-Khan, Director of PsychWorks Associates

Editor: Emily Crosby Media

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Episode 10: Acceptance and Commitment Therapy

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Dr Laura Krieger talks to me today about Acceptance and Commitment Therapy: join us for some mindfulness practice, and a wide-ranging conversation introduction to ACT and its applications in the world of personal injury.

Keywords:

adjustment, struggle, distress, emotions, relationships, stuckness, feelings, Acceptance and Commitment Therapy, ACT, mindfulness, experiential, intrusive thoughts, being in the present, grounding, noticing, values, Steven Hayes, meaningful change, action, psychological flexibility, valued living, problem-solving, validation, denial, expressing not suppressing, observing, chessboard, identity, fusion, chronic conditions, creative hopelessness, slowing down, space, avoidance, anxiety, diffusion, self as context, committed action, valued living, engaging the senses, burnout, small changes.

1:52 Introducing Dr Laura Krieger

2:20 Mindfulness practice to demonstrate one of the principles of ACT

5:39 What you notice from the exercise

7:23 Why is ACT helpful?

9:18 What ACT is about

10:44 Six core processes to psychological flexibility

13:50 Increasing the therapeutic alliance through relationships

15:24 Not trying to change difficult feelings

16:17 Noticing distress

18:06 It’s not denial

19:24 The chessboard metaphor

20:30 We are more than one identity

21:36 The evidence base

23:26 Creative hopelessness

24:58 Giving clients space

28:26 Avoidance perpetuates distress

29:40 Practical applications

37:13 Take-home message

Quotes:

7:52 “When we are in the present moment, we’re not worrying about the past, we’re not worrying about the future, so it’s a really helpful grounding strategy.”

10:09 “Meaningful change happens with action.”

13:15 “It’s not always appropriate to jump into advice giving and problem solving. Sometimes there’s a step before that the clients need, that we all need, where our feelings are validated.”

20:03 “We existed before, and we exist after the trauma. The trauma is something that has visited us. It is not us.”

39:18 “We can be the CEO of our lives.”

Guest: Dr Laura Krieger, PsychWorks Associates

Presenter: Dr Shabnam Berry-Khan, Director of PsychWorks Associates

Editor: Emily Crosby Media

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Episode 11: Running a case management business

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Ali McNamara takes us through her journey in case management, from working as an employee or an associate, to setting up a business, developing a specialism, putting support and wellbeing at the heart of the business, dealing with trauma and crises, responsibilities, work/life balance, authenticity, compliance, experience-sharing, and the future of case management itself.

Keywords:

AJ Case Management, case managers, employed, associate, autonomous, self-employed, specialism, brain injury, spinal injury, rehab, caseload, values, flexibility, mindset, CQC, compliance, wellbeing, trauma, PTSD, supervision, customer service, business model, business plan, pressure, vision, authenticity, integrity, challenge, BABICM, CMSUK, skill set, business plan, safety, moral compass, professional guidance, honesty, innovation, career portfolio, mutual respect, support, regulation, quality of life.

1:10 How did Ali get into Case Management?

4:18 Developing a specialism

6:18 Working as an associate

8:02 Choosing a way of working that suits you

10:18 Structure of AJ Case Management

11:12 Setting up the business and registering with CQC

13:29 Specialising in brain injury work

14:05 Developing the company

16:54 Having wellbeing at the heart of the business

18:40 Work processes

21:00 Capacity

23:24 Dealing with trauma and crises

27:18 Fostering a supportive welcoming atmosphere

31:16 Handling responsibility as a Director and work/life balance

34:43 Being authentic to yourself

37:42 The future of Case Management

40:16 Top tips

47:40 Sharing compliance experience and knowledge

Quotes:

4:47 “No case manager, if you’ve not done it before, will come with everything, so it’s about identifying where you want to develop.”

20:36 “You’re better to be a little bit quiet than completely overwhelmed. Making wise decisions about your working week is really important.”

45:06 “Don’t get hung up on one business model. Be innovative about the business you want to run.”

Guest: Ali McNamara, AJ Case Management

Presenter: Dr Shabnam Berry-Khan, Director of PsychWorks Associates

Editor: Emily Crosby Media

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Episode 12: Safe self-disclosure

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Today’s episode is a solo chat about self-disclosure, why we might overshare, and how to think about the right boundaries for us. As a clinical psychologist I have valued clear boundaries around self-disclosure, but practicing as a case manager can be a bit different. So this is a reflection on what feels safe, comfortable and necessary to share with our clients in the pursuit of maintaining a good therapeutic bond.

Keywords:

self-disclosure, Yalom, therapy, clinical psychology, case management, peers, over-sharing, vulnerability, psychotherapy, relationship, colleagues, self-compassion, self-acceptance, judicious, uncomfortable, confidential, personal information, accidental, unavoidable, client-initiated, deliberate, benefits, risks, personal injury, empathy, struggles, emotions, validation, imbalance, power, humanity, sensitive, curiosity, alienation, difference, privilege, boundaries, professional, human, power, boundaries, scab, scar, life experience, relatable, minimal, concise, motivation, subjective, values, misjudgment, detrimental, pitfalls.

1:00 Did I share too much?

1:10 Shabnam’s experience of sharing about parenthood at work

4:42 Self-disclosure as a positive

6:05 Definition of self-disclosure

7:37 The four types of self-disclosure

9:11 How self disclosure works in catastrophic injury work

12:10 Risks and pitfalls

15:41 Getting the balance right - a checklist

• Go for the scars not the scabs

• 17:22 Be clear about whether risks are worth taking

• 18:03 Be brief and minimal

• 19:43 Subjective vs expert opinion

• 20:17 Consider your client’s values

Quotes:

5:36 "Self-disclosure is a really useful tool when done in a considered, thoughtful and judicious way."

11:57 "Personal disclosure may serve to humanize the professional in the client’s eyes."

13:10 "There’s a question - for whom am I sharing this information, them or me?"

16:37 "Unless a clear benefit to the client can be identified, self-disclosure should not be used."

22:05 "It’s better to use safe disclosure further down the line than unsafe self-disclosure earlier on the relationship in our desperation to build a good rapport with our clients."

Written and presented by Dr Shabnam Berry-Khan, Director of PsychWorks Associates

Editor: Emily Crosby Media

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Episode 13: The benefits of Tai Chi

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Dr Giles Yeates, neuropsychologist and Tai Chi instructor at NeuroFlow Group, explains how he got into Tai Chi and discovered research on its relevance for brain injury rehabilitation; the physical and psychological effects, science and clinical impact; his charity work for Different Strokes; self-care and fatigue management; and how to approach introducing Tai Chi to clients.

Keywords:

martial arts, Tai Chi, brain injury, exercise, neuropsychology, Wudang Mountain, kung fu, rehabilitation, balance, strength, coordination, flow, Daoism, meditation, yoga, monkey mind, breathing, slowing down, physiotherapy, movement, psychotherapy, Mind/Body, community, social activities, spirituality, Different Strokes, self-care, compassion, resilience, fatigue, energy, RCT, mindfulness, barriers, adaptation, online classes.

2:08 How Dr Yeates got into Tai Chi

5:25 Discovering research on Tai Chi and brain injury rehabilitation

7:20 Psychological effects of Tai Chi

8:03 The science

12:32 Clinical impact

13:09 Psychological work through physical training

15:20 The benefits of training in community

17:20 Getting funding

18:26 Charity work for Different Strokes

19:41 Self-care

24:15 TaiChi for fatigue management

26:10 How to approach introducing Tai Chi to a client

29:45 Online classes

31:23 Summary

Quotes:

11:58 "If the brain shuts down [in flow state] it lets the universe in. We are unimpeded by our own chatter and thoughts."

12:51 "I can help you to slow down even more, to engage with everything more deeply. I’m a slowing down consultant."

15:48 "Post-injury identity reconstruction really benefits from re-engaging with social groups and leisure activities."

21:02 "If we neglect ourselves too much we will stop being able to help other people."

Guest: Dr Giles Yeates, neuropsychologist/Tai Chi instructor at NeuroFlow Group

Presenter: Dr Shabnam Berry-Khan, Director of PsychWorks Associates

Editor: Emily Crosby Media

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