Welcome to Social Work Stories, a podcast exploring social work practice through stories and critical reflection.
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But for now, on with the episode.
We're back everyone. Hello.
Welcome to the Social Work Stories podcast.
I'm Lim Fox and I'm here with Liz.
Merci. We're back again.
Happy 2022. Thank you. Hello everyone.
I think I'm feeling rusty.
It's been a while since I've been behind the mic.
I know. Apologies. Starting with an apology.
Well, it's a good place to start Liz.
I mean, we've had a bit of a break and we want to apologise to everyone for that, but it is because this summer was actually bizarre, right?
Like it was surprise COVID summer.
We were promised a summer that was a real summer and instead we got, ah, some of us in the team got absolutely knocked for six when it came to COVID isolations.
And when I say some of us, I mean myself and Justin.
And then some of us just had a normal COVID summer, right?
Like, I feel like I've got survival guilt.
It hasn't hit me and I know, I know I'm possibly just unleashed something on myself.
I live opposite a PCR testing place.
Yeah. And I've seen lines of cars earlier in the year.
I've had many, many family members who went down with COVID, of course you, me, and Justin and friends.
And I feel like I'm a bit sheepish.
I know. You should feel deeply guilty, Liz.
I can't be deeply grateful at this stage.
Guilty and grateful, that's fine too.
Look, it's so good to be back though after the summer that was that being said.
We now have floods that have hit our country.
So we've kind of gone from disaster to disaster to the next disaster it feels like.
Yeah. And I know I've got some social work friends and colleagues who are on the North Coast of New South Wales and I'm sending them much heartfelt, you know, care and concern for them.
It's tough at the moment for our coastal dwelling social work friends and colleagues.
Absolutely. Let alone the people that they're working with still throughout the flood times.
So sending our best out to everyone.
But kind of glad as well to be at the beginning of a new year I have to say, I think we've got a number of really exciting things planned for this year.
So I think it's going to be a good year to kick off.
Liz, this episode that we're going to start out 2022 off with, it's an exciting conversation and I know this came from you.
So I want you to introduce it to our listeners.
Well, I'll start with a quirky story.
So as you know our number one fans are my parents.
And toward the end of last year my dad sent me an editorial or a letters to the editor I should say and one of them was from a social worker basically talking about that social workers are doing a lot of the heavy lifting in relation to COVID response.
And it was this fantastic letter that I read and then I had to do some investigative work and I started stalking this Dr.
Josie that we're going to share the interview with.
And who is this delightful social worker who's working both in private practice but she's got years and years and years of experience and she was so happy to be interviewed by us and share some of her practice wisdom.
So her name is Dr. Josie McSkimming and she does a lovely introduction of herself.
So I think what we could do is launch straight into it because what she's going to do is have a conversation with us about what it's been like in private practice and what have been some of the issues that her clients have come to her with what it's been like to go virtual because at the time we were speaking to her we were in full lockdown.
How it shifted her practice what have been some of the practical tips that she's been able to share with us and interestingly what have been the COVID specific losses and issues that people have been wanting to talk with her about.
I found her really interesting but also quite candid in the way in which she shares some of her thoughts with us.
Yeah I think that's really true Liz and I think this is a particularly good episode for those social work students who have come in to study social work thinking that they want to go straight into private practice because Josie has some really good tips around why taking your time, getting some skills and experience behind you is actually a really good idea before launching out on your own.
So listen up if you're one of those fabulous students out there but also if you're a practitioner thinking about doing private practice and making that transition at some point I think this is a really good resource for all of you as well.
So enjoy the episode. My name's Josie McSkimming.
I have been a social worker for a very very long time.
Here I say 40 years, I've said it out there and not all in private practice obviously.
I've been a hospital social worker, I've worked for the Department of Community Services, I've worked for NGOs or all manner of organisations but more recently or when I say more recently since 2000 it's not that recent I have been in private practice and I also teach and I also do a lot of supervision.
It's exciting to have you talk about your private practice because I don't I think we've probably had one other social worker that we've spoken to who's told us a little bit about their private practice but this is really exciting because I know that's an emerging field for social workers in Australia.
Yes. Tell us a little bit about what it's like to work in private practice.
Well, look I went into private practice after I was working in Drug and Alcohol Treatment Centre and I think I went into private practice really to have more control over my work.
I found it very difficult to always be told what needed to happen.
I was getting really tired of some of the bureaucratic requirements so that gave me the opportunity to find my way therapeutically.
This was before we had any subsidies or rebates for Medicare.
This is when you were on a level plane filled with everybody else.
Like a therapist, masters of counselling, psychologists and to be honest with you, I prefer that.
I think that some of the accreditation of mental health social workers while it's the aim is to increase social works, I think credibility and visibility in the space of mental health.
I think that what it's meant is that social work as we have practiced our counselling, our therapeutic work in private practice has become just a little bit too medical and I think that that has been a danger.
Social workers always offered something different in private practice and in agencies.
We've always offered something different.
We've always had a primary focus of social justice, human rights, equity, diversity and hopefully with champion and validated those in our work.
Because of requirements of Medicare, because of competition with psychologists, it does concern me that social workers in private practice inevitably and they don't always enjoy it, find themselves speaking more about mental health as kind of inter-psychic dilemmas or diagnoses or using medical models.
While of course social workers aren't anti-medication and they aren't bound to anti-diagnosis, we're certainly anti-stigma.
I feel concerned that social workers in private practice, despite not a lot of encouragement to do so, really do need to keep that flag flying around the social creation or at least the exacerbation of mental health issues because of social inequity, injustice, exclusion from service, marginalization of minorities.
This is who we are. We don't just diagnose and treat people and I certainly don't want to see social work going that way because then we're just aping psychologists and probably not as well as them anyway.
Let's not do it. That's my kind of take on private practice.
Josie, can I ask what sort of clients that you're seeing the most in your practice and whether the pandemic has actually changed that at all for you?
Yeah, well, I had lots of people who I hadn't seen for a long time came back to me during the pandemic.
It's the nature of private practice.
Once a client, always a client, you do a piece of work and then people often come and go.
I have to say the people who I've seen less of are couples.
I have historically done a lot of couple work and that just does not work well.
I have found through telehealth, through Zoom, Skype, couples with difficulties kind of squashed up together on a couch in front of an iPad with their children all around them and distractions.
They don't find it helpful.
It's just really not an easy way to do couple work.
That's got less, much less.
Now we're starting to open up.
I'm starting to see the couples coming back, which is good.
Otherwise my practice tends to be more people who have anxiety, depression, diagnosed, if you like, anxiety, depression, substance uses.
These are the things that I specialize in.
People come to me, alcohol and other drugs, eating problems.
During the pandemic, I haven't wanted to medicalize too many of the mental health challenges involved for reasons I've said before because the loneliness or the sadness or the challenges that people have been experiencing aren't diagnosed mental illnesses in my assessment.
We're often very reactive and contextual to the circumstances that they found themselves in.
While there may be a vulnerability or a tenderness in somebody in regards to their mental health, this context has just made it absolutely dreadful for lots of people.
The isolation in particular has been a real issue, Josie.
What about people losing employment, having relationships falter because they're in the confines of their place?
All of that. You're dealing with this.
I'm dealing with this via a screen.
Relationships are often under enormous strain and people are drinking, eating more.
I tend to find that in private practice, the ways that people cope with the exploding anxiety or the depression or even the difficult situation at home.
There is an element, even though I do bulk bill, of some payment required, that the alcohol and other drugs issue becomes more focused on those drugs that somehow allow people to reasonably function so that they're still able to pay something, if that makes sense.
I tend not to see people who are absolutely homeless, chaotic with addictions that have rendered them unable to access a computer, those sorts of things.
The loneliness has been a huge thing for people who live alone before they were in ways that people could connect with one other person.
It was just hugely. That's been a big challenge, I think, for those of us who've been doing a lot of work online, is that people are really distressed on the other side of a computer screen.
When we work with people in the room, there is a kind of a real subtle way that I self-regulate and I also help the clients to self-regulate when they're highly distressed like that.
Through a screen, it is a completely different and very inadequate way of dealing with the strong emotion.
I said to somebody, I said to a woman yesterday, in preparing for this podcast, in fact, what's the difference between now you've seen me face to face?
This is after six months of not seeing me and being online.
She said, well, of course, the telehealth is better than nothing and it's a lifeline and it's a kind of a window into the home and a real connection.
She said, just looking at you through a screen wasn't the same when her emotion was really welling up, just that kind of being in the room was so entirely different.
She said she couldn't concentrate either, nearly as well, which I think is very interesting because when you're seeing people via Zoom or Skype, there are so many distractions, particularly during the pandemic because in the case of people with busy households, there's so many people there.
Women have got children running into the room and it's very hard for them.
So they go out and they sit in their car on their phones, trying to have a session, shouting at the kids, get back in the house.
It's really kind of funny.
And so the kids go, oh no, get the computer to work.
It's all of that. So it's a completely different therapeutic way of working.
Sorry, Mim, I just wanted to ask for those clients that had a relationship with you prior to the COVID.
I guess there was a history that you could build on.
That this is something that I know what it's like to be in a room with you.
In some regards, this is a supplementary to what we've already built.
For new clients, that must have been really hard to try and find the connection, the rapport building in such an, in a sense, an artificial way.
I found that very difficult and in fact, I have been very careful who I've taken on as a new client.
This is the thing about being in private practice, you actually do have the discretion and the choice to either take somebody on or not.
And I didn't take on people that I kind of thought this was going to be incredibly difficult.
Because when you actually meet somebody for the first time via the screen and they're coming with trauma, I should have said that before, I see a lot of people with trauma histories.
You have to spend quite a lot of time doing the setup of the counseling frame about what's going to happen, what we do, what kind of, what's the sort of counseling they're expecting.
Are they private? Is there anybody around?
Is there anybody who's likely to walk in?
Do they need to say anything?
Do they need to ask questions?
You know, and then of course you have the normal technical problems when people are telling you things that are very private, freezing, the computers break down, the Wi-Fi connections are always failing.
It's just terrible. Jocelyn, it's so difficult actually.
It sounds like there's so much going on in that online space.
I guess I'm thinking about all of our listeners who either are out there considering going into private practice or our students who think that this might one day be something that they want to do.
Are there any strategies that you've found through this time that actually have helped whether some of these difficult moments?
Well particularly what working online.
Well, my own personal strategies have been not to see too many people in a day if you want to be really specific because it's actually more tiring than being with somebody in a room which can be actually quite energising and innovating.
When you're actually working with somebody in the room, I don't find that I can be absolutely spent.
Whereas when you're working online, you're really trying hard to maintain your eye contact.
People are looking everywhere.
The camera is all over the place on people's different devices so nobody's really looking into each other's eyes.
You're spending a lot of time trying to look and be engaged and there are a lot of distractions for them.
Sometimes for me with emails and messages coming through, you've got to turn those off or ignore those.
I just would have thought certainly in the middle of a pandemic is not the time to start your private practice.
You know, we're hard enough with existing clients, little, only once.
Go into private practice does require, it seems to me, quite a lot of thought about how you manage yourself and your own kind of emotional ebbs and flows in your life because there isn't opportunities just to go into another room and debrief.
They just don't exist. Even if you have formal structures where you meet together for peer supervision or peer supervision, they are scheduled.
So if you actually want to just have a casual, that was a really difficult conversation I've just had.
Then private practice is probably not the place you need to be or at least not yet in your career.
Because I've got to do all that kind of self-regulation and talking yourself through things and noticing your own triggering and resonances and why things are getting to you.
You've kind of got to be able to ask yourself a lot of questions.
What am I doing and why am I doing it?
I think practitioners should be asking themselves those questions anyway.
But you really don't have somebody to bounce those questions off in a spontaneous way.
You've got to wait for the client to finish and then think.
What am I doing or what was I doing and why was I doing it and why did I ask those questions and what effect did they have?
Josie, I'm speaking from a personal space now but I've found that COVID has also forced my hand to kind of review my life and big decisions around my work and what I want to do with time.
Just made me wonder about whether your clients have come to you with existential questions that COVID has kind of hothoused them around.
I think that's very good question and I'd say it's absolutely true.
But sometimes it hasn't been helped by various kind of media suggestions and invitations around what people should be doing with their lives.
Because often there's that sense of you should be doing something more worthy or more interesting and maybe you could be learning Italian or maybe you could be making rugs for people in need.
Whereas I've found that a lot of the people that I see, these exact words have been said to me so many times I'm barely holding it together.
So if there are these kinds of invitations culturally about what you should be doing inevitably people get into those habits of over comparison and self blame and I've been found wanting.
So if anything I think the pandemic has allowed people to certainly I've wanted to help people discover what we often promote and that is it's okay not to be okay.
And in fact the idea that there are all these people who are self reinventing themselves and establishing brilliant new careers while they're in lockdown is actually potentially an unhelpful way to be thinking.
It's okay to be barely holding it together.
My experience is that's what it's been like for most people.
Those people who are unemployed or under employed and those people who are working harder than ever.
So in some ways it's a bit of a luxury to reinvent because a lot of people they're barely holding it together.
So I'm noticing now as we're starting to open up once I'm seeing people face to face they're starting to us those questions about do I want to do this anymore?
Maybe some of the pressure, it's like a pressure valve has been released.
You know it's been life changing for people but sometimes just life changing in that they've been reminded of you know perhaps their own capacities, their own skills and knowledge as their own resources that's life changing.
Sure and have you noticed that some there's been some different losses that people are now talking to you about as a result of COVID?
I'll be certainly seeing this in the hospital.
It's been the theme all the way through and what I found really interesting is that as each week went through with the pandemic it was almost like an accretion of losses.
It was just one loss on top of another loss on top of another loss.
Now I wasn't necessarily dealing with people who had COVID or had relatives or friends who had become very sick or died from COVID because a lot of that was happening in the hospital but these just accretion of losses of people they couldn't see, places they couldn't go and it was like each week it seemed to me as I talked to people had a theme.
There was some theme where everybody hit the wall together and thought they couldn't go on.
Then there was the week where everybody just seemed to be talking about grief and loss and the irony in all of this of course is that it paralleled my own journey because we were all going through it.
It's one of those rare times in social work where we're all in this together and so they wanted to know how I was too.
How's my family? Am I all right?
Isn't that lucky you got your holiday?
It was lovely in that sense of that we were all connecting around the fact that we were all experiencing loss, couldn't see people had suffered an accretion, this terrible layering of losses but I did find it quite extraordinary how each week people would talk about very similar things and each week it would be a little bit different.
It's awesome to say they're all talking to each other either.
If we had about group therapy in COVID that's the truth.
Isn't that what they say that the pandemic has been this amazing leveler in terms of that emotional response right and makes sense that you're seeing that in private practice?
Oh yes and I think look I thought it was lovely the way I could see this was the good part I could see into people's homes and see their cats and see their dogs and see everything that was going on and I often would say to people don't have your fake background, it's okay.
Let's just talk about where you are and where you're up to and they could see me too and I would have different things in the background that we could talk about and they would always ask me how I was because it was a great leveler.
In private practice people get to know things about you and so they want to ask you how you're going with such and such.
You know, a lot of my clients know that I like to get out into the bush and they said oh you can't go to the bush so it was I thought that that was a connection that was a little unexpected the way we all were in a parallel process and all were talking about it.
That's going to be really interesting to reflect on that a little bit further down the line.
I would imagine Josie just what it did to the level of intimacy with you and your clients and I'm really curious about moving out of this pandemic.
Is there anything from what you were having to do in the middle of the pandemic and the lockdown that you think you will continue to?
There are certainly people who want to stick with the telehealth and now that is a medicare permanent provision because I have a lot of people that travel right across the city to see me and if I know them well they're quite happy to not travel or maybe just every so often come for a face to face.
Particularly people I've known for a long time who I might just see monthly sort of for monitoring and maintenance it's absolutely a godsend to them not to travel.
Plus there's the clients that I have in other capital cities and around the world so this in some ways this has absolutely expanded my practice and to the extent that it's been too busy.
That's what I mean about and because nobody cancels anymore.
So I found this another curious thing.
The can go on holidays and nobody and if they're sick you still see them.
So nobody cancels. Whereas it used to be somebody gone holidays or their kids were sick they couldn't come for their session.
Now if you've got those sessions booked in chances are they will all be there because they're sitting at home and they really want to see you.
That was a curious thing.
But I'll certainly keep doing the telehealth.
A hybrid model by the sounds of things still have face to face but also off of the telehealth.
I was already doing that with supervisors who were in other places because it's very convenient.
But now you see it's never been offered by Medicare before.
So if people were sick or couldn't come to their session well you just wouldn't have it.
But this way if they can't get to their session for any particular reason be it their kind of mental health concerns too much anxiety or even if they're sick.
So as I say I mean I'm busier than ever and my other colleagues are the same.
We're busier than ever.
It's a strange intimacy.
It's like a home visit when you are seeing people online but it's a different intimacy when they're with you.
The intellectual and emotional depth of the conversation is much better face to face.
It's just there's less distractions and the run provides that containment for those conversations where I just find online and a lot of people have said this to me supervise these and colleagues.
It just feels not always but sometimes just a little shallow.
It doesn't always have the quality of the face to face work.
Maybe that's to do with our own concentration where distracted they're distracted or is it the medium?
It's probably a bit of both or all three.
It also just sounds like it's really important that you're setting clear boundaries around this both for yourself and for the other person.
Yes. Well I mean this is the whole thing about private practice that you have to learn how to do this because there's nobody going to do it for you and you learn the hard way just about always where you see too many people or you see people who are from the same family and they end up talking about each other.
It's another different kind of boundary conflict of interest problem.
When you're in private practice you kind of learn all these things the hard way when you think that is actually a poor practice decision and I must not do that.
Hopefully with very good supervision mind you but you do need good supervision when you're in private practice because you do tend to make mistakes because you're worried that you might not get enough work.
You say yes to things you probably shouldn't say yes to.
And this isn't the stuff that you learn as an undergraduate or even as a post graduate.
No, not at all. You learn it when you're doing it.
You learn it when you're doing it and people should not have any kind of idea that private practices, the pinnacle of social work or you know, healthy and days come my way when we do private practice.
It is really hard and if you the flexibility is good but the counterpoint to flexibility is that you really do have to show up.
It's a real commitment when you're in private practice and so you can't just refer people kind of think well I'm going away and so there's somebody else to see them or I'm leaving the agency and so somebody else will pick up the slack.
You're there and unless you take a huge slab of time off or retire, you're there so you have to keep showing up.
So that's why I often talk to people about be careful who you say yes to because some of this work goes on for a long time.
Josie, we're just getting ready to wind up now if that's okay but I guess I'm curious to know are you taking a break yourself when we kind of reach that magical December date?
Have you got plans to have a break?
I'm so am. I so am and the second I can drive, I'm in Sydney, the second I can drive, I'm actually driving out of Sydney.
And you know out west so that I can kind of go and look at birds and be in wilderness.
Ironically I tend to try and go and holidays where there's no phone signal.
I like no phone signal. So yes I've got much better over the years.
I mean when you're a social worker as I have been for a long time, a lot of people don't last the distance.
I love the profession and I never regret doing it but you really do have to understand your limitations.
We know so many colleagues who have been burnt out at various times and I've certainly been burnt out, burnt down.
You have to have a degree of literacy about yourself and I know what I need to do and need to take breaks.
It's I don't just push on through.
Maybe when I was 30 but certainly not now.
30 sounds so old to a lot of our listeners.
I went into private practice when I was 40 and I thought oh I'm too young.
I'm too young for private practice.
I don't have enough life experience and my colleagues said well I'm 40, I'm 38, I'm 45, yeah you can go into private practice at 40 but I did feel that private practice you really do need to be able to relate to a whole range of different people and you need to have a certain robustness because you don't know what you're going to get.
You know there's family violence, there's serious mental health challenges.
There's lots of challenges in your with someone and it's not as though you can just kind of call somebody to come and give you a hand.
God to have the skills but lots of social workers do.
I supervise a lot of social workers and they're just wonderful as long as we I think hold to what is true to us.
I think that's absolutely right Josie and it's so I so appreciate hearing you say it in that way as well.
I think it's got a road it over the years and I'm trying to fly the flag.
Well we're glad that you are flying the flag with us Josie and thanks for chatting with me.
I have something for someone in there somewhere.
Well I mean I would be surprised if we didn't hear back that there's a lot of people actually got some really useful information and really contemporary information about what people are living through and what they're bringing to you in terms of wanting your support around.
And yeah I kind of feel like people like you Josie are like the canaries in the coal mine in relation to our profession and it's one of the things that we love about this podcast is that we get to hear from people like you at really what's happening right now and what's impacting on our communities right now.
So I really thank you. You know me and when you did your introduction or to Josie's interview you mentioned that it would be really useful for people who are either considering private practice or currently in it but you know what I think, Mim.
Like I think it is that canary in the coal mine stuff.
I think practices have shifted both in the private practice space but also in the public health and community space where some of the things that Josie talks to us about are really relevant in that sphere.
You know like a lot of us are using telehealth now.
It would have been unheard of you know this time two years ago but it's part of our practice.
So some of the things that she was talking about are very relevant to our non-private practice social work as well don't you think?
Oh I think that's absolutely right.
We've moved so far in our practice so quickly actually and like to hear actually how she's been having to work around some of those issues and having to maintain privacy and confidentiality and support people in that distanced way and that can be tricky sometimes.
And I think it's great to hear the reality of that because I think we often hear about oh come on you can all do it let's all just jump in there and try the new technology and what's the best platform but actually it takes a lot more thought and planning than that.
So it was really good I thought to hear a step some of that out as well and raise some of those flags and concerns.
And I liked her hybrid model too, Mim, the way in which she can now do a combination of sharing physical space with her clients but also having the option of telehealth for those people to who you know who live on the other side of Sydney and also some of those rapport building skills I thought were really interesting that our our practitioners now have to incorporate into their practice.
Something again that they wouldn't have imagined in a million years that they'd be doing.
It's a bit similar to you know some of the techniques that our hospital social workers are having to kind of do with their eyebrows you know.
Yes that's right. All the God eyes and eyebrows.
Suddenly the eyebrows are such an important feature.
That's right. Anybody who's used to plucking their eyebrows before now they're in their heyday.
Yeah. That's so true. Look I think that was a great way to kick off our year.
We do have some really exciting stuff coming up so stay tuned everyone and we would love to hear your thoughts.
Anything you want us to be dipping into doing a deep dive on this year.
Let us know. We're planning our episodes and getting our people ready so send us your thoughts and we hope everyone is doing okay at this time given the floods yeah.
Yeah take care everyone and we will touch base with you next month.
See you soon. Bye. Thanks for listening to the social work stories podcast.
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