Now we are recognising the need for family support in rehabilitation, who do we get to provide the therapy?
While the need to support whole families in rehabilitation continues to be recognised across the medico-legal world, the depth of that support may not yet be fully appreciated.
Dr Shabnam Berry-Khan, MD, clinical psychologist and Advanced BABICM case manager at PsychWorks Associates, discusses how we talk more now about the traumatic impacts of injury on family members, and why the need to appoint qualified, regulated practitioners to deliver this support is also paramount for those living with our clients
Dr Shabnam Berry-Khan
I think I speak for the entire psychology community when I say ‘It’s about time’ that family resilience, functioning and support is being increasingly recognised as crucial to rehabilitation journeys within the personal injury world.
The recent BABICM conference helped to underline that this is now a topic very much on the agenda, as it should be. There has been a huge amount of research published which points to the fact families are key supporters in rehabilitation, with improved family functioning helping to maximise client outcomes.
For me, the fact that families should be supported, rather than just the person who has sustained the injury, is non negotiable. There is a huge evidence base highlighting the life-changing impact extends to the whole family group, and that should be recognised through the focus they are given to support rehabilitation journeys.
But also, while it is hugely positive that the need to protect and develop family resilience is being recognised more in practice, the need to ensure robust therapists are appointed is critical – the safety of these vulnerable individuals is as paramount as the injured person’s, and it is a false economy to think otherwise.
There are many practitioners who are unqualified and lack the experience and expertise for this critical role in rebuilding a family and helping them to process their trauma to support the injured client and be the resource they can be for their family member and indeed society at large so while I welcome the move towards increased support to the family system, the need to appoint the right professionals, rather than this being a ‘tick box’ exercise, should underpin this movement.
The need to support whole families
After a life-changing injury, while the person who has sustained that injury will of course need support in dealing with their trauma, the same can and should be said of their family.
The research clearly states that families lives have changed too, yet they are often expected to be super human and essentially just get on with it. But we need to remember they’re not super human; they’re human. And this terrible thing has happened to them too.
Many of us in the personal injury world will be dealing with clients who have great complexity to their needs as a result of their injury, and it is the families who are left to deal with this huge emotional distress, to pick up the pieces of the lives they all once had and try and move forward.
But still, in many instances, they are treated as less important to rehabilitation when it comes to their needs. What I mean by that is if we get a psychology referral for a family member, we can be asked to provide a cheaper version because it’s not about the client. Certainly we at PsychWorks Associates are increasingly being asked this. The opinion from many still persists to the tune of ‘Isn’t using a clinical psychologist for a family like using a sledgehammer to crack a nut?’
As a scientist-practitioner, this is difficult to sit with, especially when the evidence base – without even taking into account what we should be doing on a human level – points to how vital it is that they are equally supported.
My response to the sledgehammer comment is that providing good quality, regulated and case management-informed therapy is in fact like using scaffolding when rebuilding a house – intuitively necessary, with better outcomes and it is safer for everyone involved.
The family, and professional network, are part of that whole scaffolding process. It is our role as professionals to build this scaffolding around the client, to help create the means for the family to support the rebuilding efforts.
The importance of this cannot be underestimated – and absolutely cannot be something that can be determined on the basis of finding a ‘cheaper alternative’. The focus on the quality, experience and expertise of the therapist is fundamental to the outcome for each and every family.
Appointing an appropriate practitioner
There are undoubtedly a huge number of people who purport to offer psychology support – but this is becoming a huge issue, particularly in the medico-legal world where clients are often deeply traumatised, and one which must be addressed.
For those of us who have worked in psychology for many years, who have trained, gained accreditations, built our reputations and take great pride and responsibility in the role we have in supporting our clients – the rise of these less reputable practitioners is very worrying to see.
A BBC report recently highlighted the dangers that can accompany appointing an unqualified or under-skilled therapist, and the impact of that on a client and their family can be hugely damaging, particularly in a field where the safety of the client is everything.
For example, I have seen CBT courses offered on money saving websites, and people will probably undertake these courses and believe they can truly offer CBT because they have a certificate after four weeks. And others may believe that it only takes a quick course to be able to do complex psychological therapies, like CBT. But in reality, of course that is not the case.
What is critical here is the appointment of a robust therapist, who can meet the needs of highly complex individuals. While we understand that costs are important, and of course the rates for a regulated therapist will inevitably be higher, the risks are too important to compromise on this.
This is a highly regulated field, where those who can truly and honestly practice in the talking therapy field have the highest levels of training, they use evidence-based modalities of treatment and practice against a code of ethics and standards. They will use a protected title like practitioner psychologist and be registered with the HCPC, the key regulating body for clinical and counselling psychologists. Other reputable bodies include UKCP or BABCP for other practitioners, like systemic therapists.
At PsychWorks Associates, we only have regulated clinicians working with us, with the capacity to carry out appropriate roles such as liaising with the professional network, considering the systemic needs, and writing reports to account for their input. This is in addition to the highly bespoke support and talking therapy services they can deliver to clients and whole families, based on years of experience, and evidence-based, structured training. Unfortunately, to work with injured clients in this way with clinicians of this calibre, it means fees will reflect this skill and training level.
While appointing a therapist may be another thing ticked off the list for a client, in a field where clients are routinely so vulnerable, their safety must be prioritised. To also place the network around the client in the safest hands, putting them in a position where they can help the client make progress and be supported, rather than be potentially harmed or treated inappropriately, must be at the root of the safe, effective and trauma-informed systemic care we all aim to provide.
The ‘take home’
Family psychological needs are hugely important in getting the best outcomes for the injured person, and the cultural shift in appreciating trauma-informed care is very welcome, but we must not run the risk of ticking this box tokenistically.
We need skilled and experienced clinicians from regulated backgrounds who understand the injury context and expectations of liaison, collaboration and high-quality report writing.
By cutting corners with less robustly trained, potentially dangerous unregulated practitioners, this is short-sighted and leaves everyone open to the distinct possibility that this could undermine the very positive work we are trying to achieve for a client and their family.
- PsychWorks Associates works with seriously and catastrophically injured clients, their families and their professional networks. We provide qualified and skilled clinicians familiar with the processes around working with such injuries, from litigation to care management, CQC and collaborative working. If you feel that our team of treating psychologists or case managers could support your client or their system, please be in touch via on admin@psychworks.org.uk or via our referral form.
