Tarzan: a psychologist raised by physiotherapists

By Sarah Walsh

Lately I have been reflecting on how our experiences early in our career can shape the path we get set on (such a psychologist of me).

Recently I was wondering about how it is I came to put such a focus on behavioural changes or functional improvements in my practice, rather than the traditional focus on the severity of symptoms.

I think it is in part because, intense emotional reactions can be very normal responses for the populations that I work with, and my goals tend to centre around trying to help people be the person they want to be within the circumstances that they find themselves.

When I talk about my ways of working, people have mentioned I operate more like an Occupational Therapist, or they furrow their brows and ask “Can you still see someone under medicare?”

The biomedical model of psychopathology is strong in Australia, most talk-therapy psychologists are trained to assess, diagnose (where relevant) and treat mental illness. This is reinforced through the Medicare system of requiring the diagnosis of a “disorder” on a mental healthcare treatment plan.

This capability is critically important to individuals and to society, but can also neglect opportunities reduce the burden of psychological impact that may fall into the “normal” range of experiences or coping.

We can easily conceptualise this as something psychologists can do when thinking about the role of sports psychologists in improving the function and performance of teams, and organisational psychologists in improving the function of workplaces.

There seems to be less of a focus on this in clinical practice, with the priority being on symptom reduction. Which of course is also critical in increasing functional capacity, but often frames treatment more in terms of identifying and amending abnormal processes.

My clinical framework of treatment tends to focus less on whether symptoms are normal or abnormal, more on whether they are getting in the way of the life people want for themselves.

So, as someone who works predominately on a couch, how did this come to be such a strong focus for me and something I care so much about?

I’ve always been a person who likes to know how things work. Humans included. I think I have a predisposition to be curious about not just understanding how to minimise a deficit, but I really want to know how to provide the mechanisms of change for people. For me we can work on this whether or not their concerns meet any clinical criteria.

I felt a bit like Tarzan in my professional infancy in that, for much of my early career I was raised in an environment where I was the only psychologist in a team of physiotherapists. Pain physiotherapists too. The way they operate was focused on getting people back to doing more, not just being pain free. Doing more before their symptoms stopped them.

Progress was not measured by the presence symptoms, but by how much further they could get up a staircase before their stops them.

Not only that, but the main system we operated in was occupational rehabilitation. The entire ecosystem around our patient was focussed on getting them doing more and ideally back to being able to work.

In written communication I was schooled on how to relay helpful information that was aligned with the shared goal of the ecosystem, which was functional rehabilitation. I realised quickly that psychometrics and clinical observations on the severity of symptoms was only helpful information for me. Everyone else involved was much more interested in how workers were tracking towards their functional goals.

My communication changed, instead of listing symptoms of anxiety I would translate these into their functional impacts. For example, the worker continues to experience symptoms of panic but now can make it to the front door of their office building, where they might have previously not been able to leave the house.

To my immense gratitude, most of this work recognised the impact and importance of psychological intervention for adjustment to injury and rehabilitation.

I think considering how we developed these well established ways of working is very useful especially when considering how to support the next generation of psychologists. It’s helpful to know what are the core competencies of our profession, and where there is room to develop our own personal way of working.

How did your early career shape how you practice?