PRIVATE PRACTICE: Learning acceptance through unexpected challenges

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Running a successful private practice comes with a variety of challenges, but what happens when an external event results in a forced career break? Dr Ana C. Maloney explores how to cope with unforeseen circumstances, and bouncing back from hardship to return to private practice in a different form.

Summary points

  • It can be hard to maintain a professional identity when our ability to work is inhibited.
  • If your circumstances are preventing you from maintaining a successful independent practice, do not give up hope.
  • Keeping up with continuing professional development (CPD) events, focusing on what makes work meaningful, and being compassionate to yourself can help with finding a way back into work.
  • When returning to private practice, your focus and priorities may have shifted, this is an opportunity to become a more rounded practitioner.

Working in private independent practice demands some skills that we are rarely taught. Our strengths and weaknesses are easily exposed and the risks to our reputation and financial well-being are ever present. In uncertain times, we can become filled with self-doubt, wondering if our work measures up to that of our colleagues. A perfectionist mindset can lead to a chronic lack of self-acceptance, an overactive drive system, and symptoms of burnout.

The notion of taking a planned sabbatical from private practice is familiar and not uncommon. Considered less often, however, are forced career breaks that are elicited by unforeseen life circumstances. What do you do when you are suddenly thrown off the professional tracks you have worked so diligently to get on? What if you have to shut down your private practice against your will because something else demands your full effort?

I want to explore how unforeseen life challenges can lead to personal growth and actually benefit the quality of our future clinical work. I also want to point out that moving from a perfectionist mindset towards greater self-acceptance can help us cope better with unforeseen career breaks, and improve our chances of bouncing back from hardship and returning to the work we love.

Stones on our path

Life can be a school of hard knocks. Our psychology training often does not address the issue of how to maintain our professional identity and confidence when unforeseen circumstances interfere with our ability to work.

Working as a CBT therapist in 2006, I became familiar with the mindfulness-based stress reduction approach developed by Jon Kabat-Zinn, as well as mindfulness-based cognitive therapy, an intervention aimed at individuals suffering with recurrent depression. Over time, practicing a brief sitting meditation daily, with attention on my breath, increased my emotional resilience and ability to pay attention. I began introducing a short body scan and a three-minute breathing space in my CBT for depression groups. The group dynamic underwent an observable positive shift. Members seemed more present and accepting when listening to each other.

In 2012 I fell into an unexpected, all-encompassing carer role when my second child was born with a severe chronic health condition. I was sitting in hospitals for weeks at a time, watching my child’s oxygen saturation levels on blinking monitors, listening for alarms, and filling in feeding charts. I was stuck in a threat-based mindset. My role of independent practitioner suddenly appeared a luxury left in a distant past. The perfectionist in me was crushed. I realised that if I could not accept myself amidst all this pressure, I would be lost. Returning to the mindfulness and compassion-based techniques I had learned was an important step towards finding that acceptance.

Mindfulness practice in times of hardship

Over the years of caring for my child, I realised there are three things that protected my mental health: self-efficacy; social support; and finding meaning.

One: Self-efficacy

Psychologist Albert Bandura defined self-efficacy as one’s belief in one’s ability to succeed in specific situations or tasks. I pursued many CPD events and continued reading clinical literature, to keep my professional identity alive.

Two: Social support

Beyond receiving support from friends and family, I became better at asking for help and connected with many special people at mindfulness-based stress reduction (MBSR) training and mindful self-compassion (MSC) courses. The mindful self-compassion approach, developed by Kristin Neff and Chris Germer, taught me to look at my situation with compassion and to form a firm resolve to work my way out of it.

Three: Finding meaning

It was important to regularly remind myself why I was making all these efforts alongside my carer role. I love to help people unfold and actualise their potential. What gives your work meaning?

Mindfulness and acceptance

Regular mindfulness practice can help you build essential skills for coping with challenges. Here is a list of skills that I found particularly helpful in finding acceptance and inner strength.

Breathing practice

A regular breathing practice can help you to access a place below the agitations of your mind. It sharpens your awareness of how you breathe in different emotional states and eventually allows you to manipulate your breath to trigger a calming response in your body.

Training attention

Through meditation practice, you become more able to choose where you focus your attention. This intentional shifting of attention increases self-efficacy.

Becoming more aware and open to your thoughts, no matter what they are, can help you step out of automatic pilot and reduce mindless automatic behaviour.

Rather than worrying excessively over my child’s prognosis, I would shift my attention towards small signs of progress and live one day at a time. I began to enjoy the process of caring for my child with full attention, regardless of how dull and repetitive the tasks were. Focusing on finding beauty, like a shaft of warm sunlight in the ugliest of places, was also a helpful way to exercise the attentional muscle.

Letting go of striving

If you can engage in a process, and let go of striving for an outcome, you win more concentration and focus in the present moment. Whatever the outcome, you can simply focus on doing your best in the moment.

Accepting what is

You can learn to view your life as an unfolding work in progress. You are always growing, even if that growth does not follow a linear path. I realised that despair can eventually lead to something good and I have become less averse to negative states.

Recognising what is nourishing

In moments of extreme challenge, it is vital that you know what is nourishing and life-giving to you. Reading, journaling, painting, walks in nature, and long chats with loved ones are examples of what might feel nourishing to someone.

Noticing stress states

Many of us can shift into a goal-oriented state when we feel threatened. Today I teach my very driven clients to stop and sit, focusing only on their breath for five minutes. Even if our actions feel incredibly important and time-sensitive, we usually have five minutes to spare.

Mindful awareness can also help you to notice states of exhaustion. Our body sends us physical signs when it is getting tired. Catching them early can give us time to ask for help or to reduce the demands we are faced with.

Responding to pain with compassion

I teach my clients that there is an end to even the most uncomfortable mental states. Allowing uncomfortable material to surface, acknowledging it, and holding it in full awareness can be a form of moving through it with compassion and reducing it over time. If you develop the ability to hold pain without a knee-jerk resistance, you have a crucial added moment of time to plan considered actions.

Finding joy in little things

There is an abundance of small pleasures that can be discovered by using your senses more fully. You can mindfully savour food, textures, smells, shapes, art, a piece of music. The list is endless. You can also turn many daily routines into a mindfulness exercise by carrying them out more slowly with sharpened senses. You will marvel at all the things you did not notice before.

Moving from self-esteem to self-acceptance

Accepting yourself as you are is necessary to effect change in difficult times. Putting yourself down, or thinking about how things should be, robs you of the energy necessary to move forward with what is.

I learned to let go of perfectionist ideas of where I should be and became okay with where I was. One of my MBSR teachers noted that now is the only time you can love yourself. I practiced looking around me several times a day and accepting whatever I saw. This minimised my frustration with the reality of what is.

Accepting uncertainty

It is vital that we become comfortable with not knowing the future. It is fundamentally uncertain and outside our control.

Returning to practice: The importance of self-care

When I was finally able to return to private practice, my focus and priorities had shifted away from those of my past. Here are some examples of how I work with greater acceptance of what is:

  • Rather than having a full schedule of projects and clients, I insist on offering greater quality, both in terms of thorough screening and assessment at the outset and careful preparation and note taking.
  • Keeping larger time windows between sessions allows me to take more considered and structured notes, and to just empty my mind for a few minutes.
  • I focus on being fully present and doing my best moment by moment rather than on proving my worth to the client and to myself.
  • I can sit with silence, and awkward moments, and comment on them where appropriate. I try not to harden around momentary states of confusion.
  • I try to bring my strongest self to each session by way of regular exercise, creative outlets, and quality supervision.

My message to my clients is likely to be, ‘You are enough. You already have dignity. You do not have to justify your existence.’

Taking heart in challenging times

If your circumstances are preventing you from maintaining a successful independent practice, I encourage you to not give up hope. Facing challenges connects us to our shared humanity, our shared suffering, and brings unexpected learning that may be of use to you. Sometimes the lessons can be well worth the gap in our career.

 If you would eventually like to return to private work, I encourage you to:

  • continue with your CPD in areas that you feel passionate about
  • attend local meditation, MBSR, or mindful self-compassion groups to train your attention, awareness, and emotional resilience
  • continue to identify as a mental health practitioner, even if you have been unable to work for several years, as you have worked hard to earn your title and are more experienced than you might feel
  • maintain your network of colleagues and try to attend peer supervision events, as your insights are as valuable as ever even if you do not have a case to present
  • maintain your key professional memberships and go to conferences, where possible
  • consider part-time online work from home as it may be just a few hours per week but will allow you to step outside your routine
  • block out times in your schedule for just being, as you deserve a regular break from responding to external demands and from goal-directed behaviour
  • be sure to get sufficient sleep and exercise as it will enhance your outlook and flexible thinking.

Practice accepting your moments of suffering without resistance or effort to change them. Compassionately acknowledge the pain, possibly in combination with compassionate touch.

The process of slowly moving back toward a professional helper role is what counts. Do not worry about outcome. Just give your best in this moment.

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About Author

Dr Ana Maloney

Ana Maloney is an HCPC registered Clinical Psychologist at the Box Tree Clinic in London. She offers mindfulness-based cognitive therapy (MBCT) and compassion focused therapy (CFT) with extensive experience treating depression, stress-related conditions, and relationship problems. She supports special needs parents and teaches mindfulness and social media awareness to young people.

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