Reflective practice for psychiatrists working with people with acute psychosis

1. Reflective practice for psychiatrists working with people with acute psychosis Josephine Stanton Andre Lange Child and Family Unit, Starship

2. Overview Background Reflective practice Role plays Recording work Assistant interviewer role plays

3. Psychiatrist in Acute Inpatient Unit Requiring conversations with people who find conversations very difficult Limited volume of time for ‘being with’ Conversations often meet other people’s agendas Assessing for MHA reviews Prescriber of medication Head jailer

4. Doing this practice Very little guidance on how to do it I feel very inexpert, trying to take up an expert role - registrars People often don’t like seeing me and I can upset people - example Am I doing bad as a psychiatrist? I experience an anxiety in the pit of my stomach … a primitive fear that I can make something awful happen,

5. Reflective Practice None of us, or any piece of clinical work, is, or ever will be, perfect We are all doing our best and we can all do better. Interest and curiosity in possibilities Valuing the work we are doing, the ideas, feelings, beliefs, experiences etc supporting the work we do

6. Gambling Game Malcolm Gladwell “Blink” 2005 Turn over cards from red or blue decks Red a minefield Blue – steady diet 50 cards – a hunch 80 cards articulate theory 10 cards palmar sweating and preference for blue

7. Accessing Intuitive Knowledge Acting on experience without awareness = much clinical work Takes only 10 trials Awareness of a hunch – 50 trials Being able to articulate a strategy takes 80 trials Reflective work access experiential learning

8. Recording work Always excellent learning Consent issues with people in state of acute psychosis Role plays 2 examples Learning from each as interviewer and interviewee

11. Assisted Interview Role Plays Clinician who knows the person best takes up their role Interviewer takes up clinician’s role and stops when they would value assistance Interviewer and clinician in role of person as if behind glass wall – listening, noticing responses but not engaging with assistant interviewers

12. Assisted Interview Role Plays ctd People in role of assistant interviewers speak to clinician in the role of the person as if stepping into role of interviewer Several people come up with possible next moves Facilitator protects reflective space Facilitator keeps assistant interviewers focused on offering potential contributions to the conversation, not talking about the conversation, person etc

13. Assissted Interview Role Plays ctd Potential interventions of facilitator might be, ‘How would you say that?’, “How would you use those ideas to inform a question/summary?’ ‘So you might want to say …’ Turn to the clinician in the role of the interviewer and ask which of the statements they were drawn to, found interesting Interviewer takes that up and moves forward with it. Repeat cycle and share learning

14. Learning from this Clinician in the role of the person – experiences being in the role, experiences receiving the interventions Interviewer experiences allowing a feeling of wanting assistance and getting it Assistant interviewers can experience putting thoughts into words, perhaps taking a risk, building on ideas of other assistant interviewers

15. Learnings from this - everyone Opportunity to experience vicariously receiving interventions Opportunity to consider new possibilities Valuing different understandings, approaches

16. Learnings, everyone Making more direct and concrete use of skills and resources in team Useful for supervision, teaching, training, when team is ”stuck”

17. Learnings, ctd May serve as guidance for intervention, eg: understanding the person’s needs structure of care (as a result of adding experiential dimension)