Leaving the NHS and Starting Out Alone: An ACT Perspective

A few weeks ago I left my NHS job to work solely as an independent practitioner. I will be attempting to expand my private practice in addition to working a day a week in the local hospice providing freelance psychological input.

It’s a huge change for me. All of my working life has been in institutions, starting off at university teaching while I was doing my PhD and then moving into the NHS to work as a trainee clinical psychologist and then as a qualified clinical psychologist. I’ve worked in the NHS for over 15 years, so it was a huge leap to leave such a big and beloved organization.

So why did I do it? The primary motivation for me was freedom. I love the idea of the NHS, providing free healthcare at the point of delivery to anyone who needs it. However the everyday reality of working within such a big and overwhelmed organization was not always easy. The main issue that I struggled with over the last few years was the lack of autonomy. I found myself at the mercy of edicts from way up high that insisted I did things a certain way, even if the procedure made little or no sense to anyone working at the coalface. I had a tonne of bureaucracy and was forced to attend an array of meetings, for some of which the word “interminable” was a vast understatement. I had little control over my day and had to fit in with the rest of a large, unwieldy machine.

Practically this didn’t always suit me. For example, I am a morning person and get less productive as the day goes on. All of my NHS clinics were in the afternoon simply because that was when the room was free. I would sometimes spend the mornings in meeting after meeting and be quite wiped out and tired by the time the part of my job that I considered to be my “real work” (i.e. seeing and helping patients) started.

Then there was my home life. I wanted to be able to see my children more and pick them up from school. My standard NHS hours just didn’t support this and I was always rushing back home to see my children, put the tea on and make packed lunches before bath time. This wasn’t conducive to a peaceful and relaxed home life and I didn’t want to pass on the sense of being rushed and overwhelmed to my children.

However there were many lovely things about my NHS job. The department I was in was very warm and supportive. I had lots of friends there and I loved going in and chatting to the admin team and my therapist colleagues in the morning. If I had a bad session, there was always someone there to support me and bring me tea and biscuits (literally). I knew I was going to miss the buzz of working with such a great bunch of people and bouncing ideas of a group of psychologists. Of course I love working with patients, but I would continue to do that independent practice.

So what tipped the balance for me? It was thinking about my values and the direction I want to go in life. Acceptance and Commitment Therapy (ACT) is an approach I use a lot in my work with patients and I also use it myself. ACT focuses on two main strands: being willing to be present with your current experience (acceptance) and working towards what really matters to you (commitment).  Both of these strands were important in knowing the direction that I wanted to go in. When I sat down with my emotional experience of being in the NHS, I noticed feelings of being stuck and stunted in my growth. I felt a little like a 19 year old who is ready to go to university. Nervous (actually, terrified) but also realizing that if I didn’t leave I would forever feel as if I was putting a stop on my own development. The image that came into my head was of a flower growing up against a closed window and hitting the glass. If I didn’t open the  window, the flower would bend in on itself and ultimately turn away from the sunlight and the direction that it wanted to grow.

When I think of my values, these four words come up for me: love, peace, joy and freedom. Values can be much more specific than this (e.g. two more specific values for me are being a good mother and being the best therapist that I can be). However my overarching, higher-order values are those four key words: love, peace, joy and freedom. I knew that to meet those values (particularly the last one) I needed to take the leap and leave the NHS. Yes it felt safe, secure and like home, but the flipside was it was stultifying, limiting and it was time to leave my metaphorical home: it was time to fly.

So I did it: I handed in my notice. It was not an exaggeration to say that I was terrified. But I took a deep breath and I jumped.

It’s early days for me and sometimes I am still scared. I woke up (well got woken up by a 4-year-old) at 2am last night and couldn’t sleep for a while. I was suddenly terrified again: would I have enough patients? I haven’t had any new referrals for a while, why not? Should I be advertising? Will I survive this? So I used my ACT skills and I sat with the fear, it felt like a white cloud on my chest. It was cold and very uncomfortable. I like to use the mindfulness phrase of “lack of contention”. I made the decision not to contend with this fear. I sat with it, welcomed it and listened to it. Emotions always like to be listened to. I relaxed and the fear calmed down.

And I remembered. I remembered my values: my family, being a good therapist. I remembered my four key values. Love: of my family and for people who ask for help. Peace: to be peaceful with the people I love, I need to give myself more time, more space. Joy: to be joyful I need to have the time to engage with life, to not worry, to play. And of course freedom: to be free I need to allow myself to move out of the shackles of what seems safe, to take that leap and fly.As I therapist I have sat with many people on the cusp of big decisions, always hoping they could make the leap. How could I be a good therapist if I wasn’t willing to do the same myself?

Have I regretted it? Not once. Not even for a moment

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