Currently, most people change jobs much more frequently than their parents or grandparents may have done. Psychologists are no different, often moving from employed positions to self-employment to portfolio careers, sometimes combining teaching, writing and applied services. When Ian Florance first interviewed Sabah Khan last year she was a lead for training in Tavistock Relationship’s innovative Couple Therapy for Depression. Since then her life has changed dramatically.
In this two-part article, Sabah talks about these changes. First, what was Sabah thinking about her work at Tavistock Relationships when we talked last year?
The relationship is the patient
‘We have a very tight focus on supporting couples, children and families using psychodynamic and psycho-educational approaches. We’re part of the “Tavistock family” of organisations that grew up after the Second World War to intervene in important social problems, although we moved out of the Tavistock and Portman NHS Trust’s building in 2009. We now depend on securing project bids. These are typically time- and geographically limited, though the internet helps speed up and create better access for roll outs. These projects focus on different aspects of relationships: depression, onset of dementia, effects of retirement and loneliness, and many others. As society changes, we create new programmes.’
Visiting clinicians make up the bulk of Tavistock Relationships’ staff. ‘The majority will have trained here. Many set up private practices after their courses, but some stay on. That’s what I did. In addition to clinicians there are marketing, research, policy, and other staff, and then core faculty, of which I’m a part. There are only a handful of psychologists – our focus is on couple therapists from whatever background. We’re a very diverse group.’
How did Sabah come to work in the organisation? ‘I saw Andrew Balfour, now our CEO, presenting at a Neuropsychoanalysis group meeting about the impact of dementia on couple relationships. I came to an open day at Tavistock Relationships, then undertook the postgraduate diploma clinical training in psychodynamic couple and individual psychotherapy during the evenings whilst working as a Clinical Psychologist at the National Hospital for Neurology and Neurosurgery. Then my two lives crossed-over: a patient from the National Hospital was referred to me here and I could finally put into action the two areas I’d trained in. Once I’d completed the programme, I stayed on as a part-time volunteer clinician. I then left the National Hospital three years ago to take on a Principal Clinical Psychologist post at Imperial College and worked two days a week as a clinician at Tavistock Relationships, keeping both worlds in motion. But within two months I was offered a faculty post as lead trainer for the Couple Therapy for Depression project. That meant coming on the MA in Psychoanalytic Couple Psychotherapy, an additional two years to the previous three I completed: it was an intense investment alongside a full-time post and included starting three-times-a-week analysis. It made me realise that unless you engage in a deep self-examination, it’s harder to connect your clinical training with your internal world. That was a profound learning for me.’
Sabah is involved with several projects. ‘Living Together with Dementia is one. I’m also project lead on the Couple 50+ MOT Programme. That’s funded by Calouste Gulbenkian to help couples face the transition to retirement. I had to design a brief intervention model, clinical training and a clinician’s handbook and was delivered through related weekly group supervision. A pilot in London worked well last year and we are now rolling out training in Leeds, London and Bristol to AGE UK, NHS teams, Marriage Care and RELATE. Our work generally takes place when distress is already occurring. This project is different in that it’s preparing for the process of change – the loss and gain involved, and the possible challenges retirement might cause. The losses can range from a real loss of self-esteem when someone no longer possesses a job title with which they closely identify, to finding that living together 24 hours a day causes tensions that weren’t there during working life.’
Tell me a bit more about Couple Therapy for Depression. ‘We worked with Relate to develop competencies from the existing evidence base and then designed clinical training. Our research project showed huge incidence of undiagnosed and unreported anxiety and depression. The training course is a CPD for therapists and involves five days teaching and group supervision for clinical work. Clinical sessions are recorded, the students rate themselves, and supervisors mark that material. I have to say I really enjoy that part of the training. The whole programme aims at relationships where mild to moderate depression is causing distress. Maybe one client is “holding” the depression but ultimately the relationship is the patient – and that relationship offers resources to improve things during stressful times. It’s a way of managing acceptance: moving the relationship to a realistic position where it can bear loss, disappointment and change.’
What are Sabah’s present interests? ‘I’m compelled by two different specialisms – psychotherapy and neuropsychology. During my clinical doctorate at UCL I was determined to have placements in both areas. I went back to the National Hospital and worked in the stroke/acute brain injury unit. Group work enabled me to use more of my time for therapy, as opposed to only neuropsychological assessments and brief follow ups, and I started running groups for sufferers from stroke, MS and other conditions. Then, as mentioned earlier, I saw Andrew Balfour talk and found a way to bridge the gap.’
I expressed surprise that someone who was involved in psychotherapy would also find neuropsychology so interesting. The two are often typified as separate. ‘Well, Freud started in neurology and was influenced by neuroanatomy, and I’m interested in both areas. I suppose I see equal validity in trying to understand the scientific causes of a condition as well as its meaning to the individual. The two areas support each other, and this is what I’d like to go on to apply in my work.’
What’s next for Sabah? ‘Having been trained in both worlds – neuropsychology and psychoanalytic psychotherapy – I want time to reflect and work on the connection between them: to create interventions which combine underpinning reasons and lived experience. For this reason, I am stepping down from my faculty post. I’ve learnt so much from Tavistock Relationships but it’s time to make a transition into a different relationship. I think clinical psychology can be relentless. I never had a gap year and seem to have been continuously studying and working for a long time. Last year I went on a 10-day silent meditation course and since then I have been trying to practice the principles of the dharma in my everyday life, which is all a big change for someone from a Muslim background.’
Three months after this interview, Sabah left TR. She put her part time private practice on hold to travel around Japan, with further thoughts on how to make the full transition into private practice, including marketing and developing writing projects.
What’s happened since
‘I’m now working as a visiting lecturer and supervisor for Tavistock Relationships, delivering Couple Therapy for Depression: I ran three training courses in March. I reserve three days a week for private practice. This reflects my view that clinical psychologists tend to take on too much work. Friends warned me about this and I am careful of over-filling my time, which is very possible with private work. There are still stresses but the variety of work is really rewarding.’
Did referrals come about through the sorts of social media marketing channels we talked about last time? ‘No, not really. It’s largely through online directories, and some through colleagues. I’ve also finally been lucky to start couple psychotherapy with neuropsychology patients through a private company called Hobbs Rehabilitation. Hobbs was set-up by two physiotherapists to offer rehabilitation for a variety of conditions. They’re now offering services in ten locations, all in the South of England but none of them in London. They’re trialling couples’ services. One of my former training supervisors, Dr Ben Papps, advertised a neuropsychologist post and I asked him if he’d be interested in focusing it on couples. He said it had to be a general neuro-rehabilitation post but shared the information with Hobbs. I was tempted by their offer to take on a general neuro-rehabilitation post, but couple referrals have started to come in and I’ve decided to continue to be a self-employed consultant focusing on couples in neuro-rehabilitation. In the end, I felt this is what I wanted to tie together since my work at the National Hospital: I would love to see how it works in practice.’
Sabah has also just started a new service to couples with a chronic illness, including neurological conditions. This combines her interest in neuropsychology and in couples therapy.
Psychologists becoming self-employed often struggle with marketing their services. ‘One of the best routes I tried was personal contact. Clinical psychology is a small world and it should be easy to keep contacts. Having a variety of trainings has also been helpful as it means a diverse range of people come through my door. Having clinical psychology as a foundation means I can work with a range of different presenting issues, saying no to some of them and realising that you might not be the right person for a job, is fundamental.
Are you writing? ‘I’ve started a blog but haven’t had as much time as I thought I would as it’s been so busy. I haven’t given up the idea but I’ve put it on one side at the moment.’
You raised issues about how relentless clinical psychology can be. How has the change of job affected your life? ‘Slowing down and having a break last summer was important, and was helped by continued meditation practice. My personal and work life are now more in harmony. Some of the clinical ideas I use are sourced in dharma – and the idea in dharma of the balanced mind is very important. In a sense psychoanalysis and dharma practice are two models of mind that ring true for me. They both share a relationship with an object, whether that be an analyst or a spiritual guide, the major difference, however, is the extent of the goal: for the former it may be to live with less conflict, but for the latter the mission is to completely end suffering and live harmoniously.
Have you any further advice to someone making the transition you’ve made? ‘Working privately is very different from working in the NHS or in an employed position and I’d say don’t be afraid by that. I’ve taken a risk, not least financially. It still feels odd not to have the institution behind you. But it does feel more secure and I recommend having links to groups and associations that you believe in and be sure to go to CPDs and workshops because you want to, not just because you think you do. I think blending my work into life in a way which feels nourishing has been key – I can go to an art exhibition or theatre show, and make sense of it through psychoanalysis and dharma, which in turn enables me to think about what’s going on in the room and what’s going on for me. Slowing down has helped but it’s been invaluable to have a supervisor I meet with regularly and to be in analysis during this change. I’m finally working with a range of clients, the way I like, with real intimacy, and I’m excited in developing couple psychotherapy in neurorehabilitation. All of these changes have helped me to move to a more authentic path and feel happier about my work than at any other time.’
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