SPEAKERS

Rosie Gilderthorp, Kirsty Harris

Hello and welcome to the Business of Psychology podcast. Today's episode is the final episode in our series about different ways of working. And it's an unusual one for me, as Dr Kirsty Harris isn't here talking about her private work. In fact, she doesn't even have a private practice. But she has written a much needed book about endometriosis and how to support your mental health if you know or suspect that you have the condition. I'm really glad to be concluding this series with Kirsty's story as I found our conversation enlightening, but also troubling, as this is another example of a group that isn't receiving the support that they deserve from public services. And it's a really great example of how our work as mental health professionals can make a big difference, even when it's outside our official role.

I hope you enjoy the interview.

In this series, we're exploring the different ways that psychologists and therapists can get their work out there. And I've been talking to a lot of authors recently, and I've been really struck by how people have found inspiring and helpful ways to use their personal experiences in a professional capacity. So I've been looking forward to our interview with Dr Kirsty Harris today because Kirsty is a clinical psychologist who has recently published a book called Coping with Endometriosis: Bringing Compassion to Pain, Shame and Uncertainty through the Association for Clinical Psychologists Coping With series. So welcome to the podcast, Kirsty. Can you start by just telling us a little bit about your career as a clinical psychologist? Maybe how you got started and how it's evolved?

Yeah, so, I think like many people I decided I wanted to be a clinical psychologist without 100 percent knowing what that entailed, and became quite focused on that quite early in my life as the path I wanted to take. So, I took a relatively traditional route for clinical psychologists. I did my undergraduate degree, did a couple of years as an assistant psychologist in a mental health hospital, and then went on to do my doctoral training after that. So I've been qualified nine years this year, I think, since I did my training, may even be 10, depending on your maths.

So just picking up on that, I didn't really know what being a clinical psychologist entailed either. I'm glad you've admitted that. What do you think it was that drew you to it when probably none of us really understood what it involved?

Well, I think I didn't know what the process was to become one. I had this idea that it would be a profession that would help people, but it actually was born out of an interest in history. So when I was at school, I was fascinated by historical events where there had been what I now would call collectivist trauma, but at the time I just found as, you know, the war, or, you know, World War II as an example, I remember doing that at school. And, I spoke to the history teacher about this interest and she said, I don't think you're interested in history, I think you're interested in psychology. And I had never heard that word, I didn't really know what that was and became aware then that it was about people, it was about studying people and how people worked and how their brains worked and how they behaved. And that really captured my interest. And I think I sort of followed that then, pretty almost single mindedly really. And clinical psychology came about in part for the reason that you were paid to train. So I, the other professional avenues weren't that open to me. I was the first one in my family to go to university. I was the first one to think that a career like this was a good idea, possible. So it was partly drawn by, I could work while I was doing it, and I would be paid to train, and I'd got a secure career in the NHS afterwards, and working in the NHS was the goal for me when I started out. So I think I sort of followed this path of people, which was fascinating and still is.

I think that's really interesting. I think for me, it was similar that the fact that you were paid to train, it felt almost too good to be true. And also like the only safe path, whereas everything else looked a bit like a crazy risk from my perspective at the time. So that's really interesting. Thank you for sharing that. So how did your career evolve then? Because obviously the training as a clinical psychologist is really generalist, and so you kind of emerge from that, you know, almost able to do everything and feeling a bit like you can do nothing. So how did you end up where you are now?

So I worked in inpatient services as an assistant and then again when I was newly qualified. So that's mental health hospitals and working with people with acute mental health needs and I predominantly worked with women. I worked on women's units mainly. And I loved that work. I loved acute work. I found it very interesting, but it's also very intense and requires a lot of dedication and energy and time. And then I fell pregnant and I had my daughter and suddenly the path that I'd been convinced I would take for the next 30 years became more challenging, didn't quite fit with being a mum and trying to maintain my professional role in the way I wanted to do it. I think it's really important that you're trying to create a way of doing your job that works for you as a whole human person. This is a job that does have a degree of vocation in it. We do it because we really want to do it. If we didn't feel that way, I don't think we'd do it. This is a real, it is a vocation in many ways. So it was important to get the balance right. And that led me out of inpatient services. And I'd had this interest in perinatal since I trained, which is what I do now, perinatal mental health, which is birthing people and babies. And the perinatal services were just being commissioned. So they hadn't existed before and they all came out of the five year forward view for mental health in the NHS and we got this perinatal mental health team in my local area. And I took the, at that time, only psychologist post for that team and we're nearly six years on from that and I now lead three different pathways with about 15 psychology staff across those pathways. So it kind of grew from there and the majority of my time has been in perinatal mental health.

Wow. I mean, thinking to where we were only six years ago to have grown the service to that extent, what's that been like being part of that kind of rapid change?

It's been an unbelievable privilege and incredibly challenging. I am really humbled every day to work alongside people that have put so much effort into making the landscape different for women and for birthing people. And I think that's also the motivation behind the book to some extent, is that my experience as a woman was not one where we were championed within healthcare or where I was always treated with respect or compassion. Certainly not one where I could access all the help that I needed at the time that I needed it. And I think although the services needed to be very fast paced and what we do has had to adapt and evolve all the time, we've been able to do that. We've had the support to do that. We've had the skills to do that. We've had the team behind us to do that, and that's a rarity, I think, in what has been the recent climate for healthcare.

Yeah, it does feel like perinatal had a particular emphasis on it at a time when it was really badly needed, but a lot of services were not getting the attention either, you know, through the media or with government spending. Yeah, I can really relate to that feeling. But it sounds like for you, there was always something about wanting to support people whose health hadn't been prioritised in the past. And we know that there is a lot of research about health inequalities in terms of the amount of research and the time that's been spent investigating issues that might've been termed women's issues in the past. So I can sort of see the link there between perinatal mental health and endometriosis. I mean, certainly as, you know, as a woman, as a clinician working in that area, there's a huge amount of overlap there. But what is it that made you feel that this book was needed at this time?

I think some of it was opportunity. I think this book was always needed. I needed this book 20 years ago, 10 years ago, five years ago. It's always been needed. It was that the opportunity came along now. I had this idea that I'd like to maybe share my experience somehow. It doesn't come up in my day job. It's not something that really feels appropriate in that setting a lot of the time, probably all of the time, but I thought it was valuable. And there was lots of times where I thought it could be helpful to other people. I had no idea where to start with a book or how to get my experience out there or what to do with it. And I saw the advert with ACP-UK who were doing this series and it made sense, it was the right time, it was the right opportunity. I thought I could do that and I applied to write the book and they accepted it and kind of off we went. In some ways it therefore didn't feel like the most conscious decision. It was more the opportunity came along, I thought I'd give it a go, I didn't know whether it would happen or not. Even at this point I'm quite surprised it has happened, even though it's out there and I've written it, still feels like a bit of a surprise, but it kind of came about quite organically in many ways.

It sounds like there was almost the idea for the book bubbling under the surface for a long time and then the ACP came along and said, hey, we've got this way to make it slightly easier for you and your brain looks kind of leapt on it.

Yeah. And I think that's been my approach with many things in my life. Sometimes something comes along at the right time or it's the right opportunity and I'll try and follow that. It's not been an easy process because it isn't and I don't know that it was, you know, again, it wasn't that I thought, oh, it must be a book or it must be this, or it must be that. I just knew I wanted to get that information out there somewhere, and this seemed like a very good way of achieving that, and hopefully it has been and will be.

So can you say a little bit about who this book is for, who you're hoping it's going to reach and make a difference to?

So, the book is for anybody who menstruates and finds that difficult. We're often talking about women, and we will talk about women in the podcast, and I'm sure we'll fall back to that language, but the book is for anybody who has a period, and anybody who thinks they might have endometriosis. It's not for people who have definitely got it, or have been diagnosed, or know where they are along the journey, or it's not just for those people, I should say. It's not just for people who know. Because for 20 years, I didn't know. Not for sure. I didn't have a diagnosis. I thought it might be, thought it might be endometriosis. I'd heard that phrase, but it was 10 years before I'd even heard it. And it was another 10 before I knew for sure.

Wow. Why was that? How does it, why does it take so long to get a diagnosis?

Well, minimum, on average, it takes eight years to get a diagnosis, according to the latest research from the NHS and Endometriosis UK and other organisations. There's lots of hypotheses for why it takes so long. A lot of them revolve around what we were talking about earlier, about women and menstruating people not being listened to, not being heard. I think the condition itself is incredibly complicated, the medical profession are still learning, so I personally don't blame the medical people that I've come across, medical professionals I've come across, who have sent me away, who have not known, who have said that it isn't anything. I don't think that that was done out of maliciousness, I think they didn't know, this understanding wasn't there 20 years ago. So I think it's a combination, I think, of people not knowing. I think there's a lot of stigma and shame about going and asking for help. Endometriosis isn't just a period problem. I was told for years it was a period problem, but actually it can affect your bowels, it can affect your bladder, it can affect your lungs, your legs, your back, your hips, your everything. And a lot of these things, like going and talking to the doctor about your bowel problems, or your bladder problems, or your problems with your sex life, or your problems with your bleeding. These are all quite difficult things to talk about, you know. Again, the research shows that the majority of women are still embarrassed to talk about these things. It can be embarrassing, it can be stigmatising, it can be shaming. So you've got to talk about it to somebody who might not receive it in the way that you'd hoped. You've probably got to talk about it more than once, you have to keep going back. And then you also have to go through procedures to know for sure because the only way to know 100 percent if you have endometriosis is to have a laparoscopy, which is a surgery. So for myself, there was conversation of, oh, we think it's that, but I didn't have a laparoscopy until much later, couldn't get access to that. So it's a very complicated journey to get to that point. I think there's so many things that get in the way of getting that diagnosis. And there's lots of comorbidity as well. So in the end, mine was endometriosis and adenomyosis.

Do you mind me asking what that is?

Yeah, so adenomyosis is a condition of the womb lining, so that's been talked about a lot recently. It's incredibly painful, but it is limited to the womb itself, whereas endometriosis is a tissue like the lining of the womb, it's not actually the lining of the womb, it's like the lining of the womb that will grow in different places in the body and then becomes inflamed and bleeds and can cause adhesions and pain and other problems.

Gosh, I mean it sounds like such a serious thing to be dealing with and such a serious condition and yet the pathway to getting a diagnosis, let alone treatment, is so challenging for people. I can really imagine, certainly my experience, and I think quite a common experience these days, is that when you go to the doctor, you almost have to tell them what tests you want run, who you want to be referred to. It feels very, very much like a patient has to know what's wrong already and say, these are my problems, please refer me to this person, because there isn't the time for that holistic view where they might look at a whole range of different symptoms and put the puzzle pieces together. I mean, maybe that's unfair, and I'm sure that there are primary care doctors out there who are absolutely putting the pieces together, but that does seem to be more difficult these days than it has been previously. So I'm just imagining a woman who, a woman or a menstruating person who might be having these difficulties, but maybe hasn't heard of this before, or it's so stigmatised to talk about that they've not raised it with other people that might be able to tell them about this or their friends or their family. How are they ever going to navigate this process?

Yeah. And I think that’s partly what the book's for, is to try and help you navigate the process and know where to start. And the book is structured as an almost, you know, self help book. It's got worksheets in it, it's got the things you can fill out and take to the doctor with you, and show the doctor, and use to guide your appointments and advocate for yourself. I think there's also something about people speaking up, role of social media, role of podcasts like yours. This is how people access information now, is they access it through these kinds of platforms. So trying to get accurate information out on those platforms from people who have got the expertise and the knowledge. The huge advantage of social media and the internet and platforms is that you can have access to a massive amount of knowledge. The disadvantage is it may not always be reliable. So trying to make sure that we're getting reliable information out there. And I think being able to help one another and know that you're not alone in this. The NHS is structured that obviously each professional background is its own profession, you know, own thing, psychology is the same. So, for example, for myself, because my, one of my first issues was with my bladder, so I ended up under a urologist for ages because I've got a bladder issue and the urologist isn't going to talk to the gynaecologist. So then I was under a gynaecologist and they were two separate things when actually it all came to all, they were all part of the same thing. It was years for people to work that out. And some of the symptoms with endometriosis for me were not anything I would imagine as being to do with my period. So for example, I had leg pain. Leg pain was one of the worst symptoms I had. It was agonising for years, it's pain shooting down my legs, into my knees, into my hips. You don't imagine that leg pain is anything to do with your menstrual cycle or hormones or periods, but it is a symptom of endometriosis. I didn't know that.

That would never have occurred to me.

No, it doesn't. It doesn't occur to us. But it is, it's one of the main symptoms. And again, if you look to other women who are experiencing this, leg pain is something that's talked about. But it wasn't until I got access to a community of other people with the same experiences that I was having that I realised other people had leg pain. And then I started questioning, well, if they've all got leg pain and similar symptoms to me, and I've got this leg pain, maybe that is to do with my endometriosis. And when I had my hysterectomy and excision surgery, when I woke up from that operation, came round to the general anaesthetic, my leg pain was gone for the first time. And that's how I knew for certain that it was being caused by adhesions and the complexities of what was going on inside my pelvis.

It must have been a big decision to have the hysterectomy. How, what did that feel like?

It was an enormous decision to have the hysterectomy. I was 33 when I had that and at that point, I didn't know for certain that I had endometriosis, I hadn't had a diagnostic laparoscopy. I was 90 something percent sure, but I didn't know 100 percent. I knew I had adenomyosis because that had been diagnosed with an MRI. And I knew that removing my womb would eliminate the symptoms connected with adenomyosis. But I didn't know which of my symptoms were being caused by adenomyosis and which of my symptoms were being caused by endometriosis. I also didn't know what else was happening inside my pelvis. So I was going into the surgery with a lot of uncertainty of what that would mean, how that would pan out. We hoped that the surgeon would be able to save my ovaries. We didn't know whether he would be able to, whether it would be both, whether it would be one. So the only thing I knew for sure is that I would lose my fertility and I knew that I would be able to eliminate the adenomyosis. But other than that, I didn't know for sure what would happen. And I decided that that was a risk worth taking because of where I was at at the time. My symptoms had got to a point where my day to day life was significantly impacted and I was more disabled by the illness than I had ever been and I knew that something had to change. And I went through over a year of therapy in helping prepare for that decision and helping me to feel that it was the right decision because it is also an irreversible decision. So if people are out there, you know, considering this, it is a huge decision. It does take time to make that decision. I had to find the right person to do that. I did have the ability and the privilege to choose a consultant and I would access my surgery privately so I could choose my consultant, who I had trust in and who I knew had the skill and expertise to do the surgery. But I knew that I needed a change and I couldn't see a way of keeping my womb and keeping my menstrual cycle intact and getting the level of change that I needed. And I felt that that, and I still feel that was the right decision for me.

It must've been really terrifying going in with so much uncertainty. And what strikes me is they hadn't done a laparoscopy at that point. So that, I mean, it seems a bit crazy really, that they would do a hysterectomy before they would do a laparoscopy. What was the thinking there?

So I could have waited and had a diagnostic laparoscopy. I had been offered that on the NHS. I was on the waitlist for that. This was just, mid-COVID, so waitlists were the longest that they'd ever been. We have to bear in mind that gynaecology waitlists were the most significantly affected by the pandemic and remain the most significantly affected. So it's not unusual for people to be waiting two years, three years for access to these procedures. Endometriosis is an incurable disease and it may well progress over time, and for me it had progressed over the time that I'd had it. And I didn't want to go through multiple procedures. I was pretty sure in my own mind that that's what it was. And I could have waited, had a diagnostic laparoscopy, confirm that that's what it was, perhaps had some excision surgery, see whether that made enough of a difference to me to improve my quality of life. I could have then considered another operation after that, had I needed it. Many people with endometriosis will have repeated laparoscopic surgeries. They will have repeated excision surgeries. They may have ablation surgeries. They may have all different kinds of things. I didn't want to have lots of operations. And I, for me, the main reason not to have a hysterectomy would have been to retain my fertility and I didn't feel that I needed to do that. I was happy with my family, I was, I'd have got a daughter, have a daughter, I was privileged to have had her. I couldn't envisage going through another pregnancy. We were both content in the family that we had. I didn't need to preserve my fertility, so I decided to go for one operation and try and get the maximum benefit from that. But I had to tolerate the risk of not knowing what it, what would happen, but I would have had to tolerate that anyway.

It makes a lot of sense, but it does leave you thinking, you know, if this was more of a men's health issue, I wonder how much further along we would be with making this easier and more comfortable for the people experiencing it. Because that feels intolerable, that amount of uncertainty.

And I think it would be different with different people and different journeys. Everybody is unique in this, you know, some people will have their diagnostic laparoscopy much earlier, some people are trying to preserve fertility or they have other priorities. Everybody's surgeries are different. It is really about the decision that's right for you, and that is a difficult one. And I think maybe we'd be further along, I don't know, we’ve got to bear in mind that, you know, the majority of gynaecologists and so on, certainly that I've met are men, and they've dedicated their lives to trying to make things better. Certainly the consultant that did my hysterectomy had dedicated his entire professional career to working with women and people with endometriosis, and was a real expert in that area. So I think there are people out there, regardless of gender and sex, that are doing absolutely everything they could and they can, but it's a much bigger issue. You know, it's costing the economy something like eight billion pounds or something a year is the latest data. I mean, time lost in work and employment, and the health care cost and mental health cost and all the other things that go along with this. I also think it's such a monumental issue that it requires so many people to make change at all kinds of levels.

Yeah, it's very difficult, isn't it? Because it's not like there's a quick fix that it's oh, well, if you just put a few million into funding this, it'll all be fine. Actually, it's that kind of systemic change that needs to happen. Probably starting with education for children, all the way through to primary care, secondary care. It's a big challenge.

And I think that's where the book came about, was also psychologically, this will always be challenging. So I hope in 10, 15, 20 years, we have a health care system that is set up for people with the difficulties that I have had and you can go and get your diagnostic laparoscopy and they bring the diagnosis time down to less than a year, which is what is the current aim. You know, within the next sort of 5, 10 years that you know what's going on for you, that you can access the treatment, that you've got the specialist that you need to talk to, that the GP knows where to refer you to. I hope all of that changes and that makes the process more streamlined. But I don't necessarily think it will make it easier for you to live with it. It's incurable, it's one of the 10 most painful conditions, in all the research, it has an impact on your fertility, it has an impact on your relationships, it has an impact on your identity. You go through all different kinds of treatments, fantastic that you can access different kinds of treatments, but they all have challenges. They all have side effects. They don't all work. Psychologically that's incredibly difficult. And even if everything else is in place, I think it will still be difficult to cope with. And that's what the book is about. When I was writing it, I really ummed and ahed about, do I write about all the experiences I had, and all the symptoms that I suffered, and all the procedures, and medications, and everything that I tried. And when I first started writing it, that was sort of the plan. And then I realised that there's lots of information out there on treatments and procedures and all of those things. There's very little information about how you cope with that, or how to live with that, how to tolerate that, how to navigate the impact that that has on who you are as an individual person, and what it means for your relationships and other people around you. So I restructured it all and that's what the book became about. It's less about the symptoms of it all, although obviously they're in there, and more about the psychology of it and the distress, managing the distress that comes with it, because I do think that that will remain, even if processes improve, because it's a very, very, very difficult illness to navigate.

I think that sounds really valuable because so often I hear this about different things, but a lot in perinatal mental health is, oh, I know I should be grateful because… So, you know, they're maybe given some kind of treatment, and it's not working or it's got really invasive side effects that are really challenging, but they don't feel like it's okay to talk about that really outside of therapy, perhaps where it might get aired, but like, even with friends and family, people are soldiering on and, you know, just feeling that they should be grateful. And I imagine with something like endometriosis, there's always somebody that you can look at and think, oh, well, it's worse for them than it is for me, so I shouldn't say anything, and I hear people doing that to themselves a lot.

And that's an ongoing thing for me with the book I, and I wrote about it in it, had that anxiety of did I suffer enough? Was it bad enough? Can I actually say anything about this? You know, particularly when I was writing about fertility, there was part of me that was going, but you've got a baby, you have a child, and there will be people reading this book that have not got that. So how can you say something about it? How can you comment on it? But I think you have to, because it isn't that straightforward, and your experience will be different to somebody else's. That is a certainty. Nobody out there is going to have an identical experience to what you have or what I have had, but they will share some of it, might share quite a lot of it actually, and they might certainly share the emotion of it, even if the journey was different. And if you therefore say, oh, I don't want to talk about this because somebody else might have had something more significant, or we kind of feel the problem ourselves because we come to compare ourselves with each other, of who's worse. And I don't think that's anybody's intention, to go this was worse for me, or, well, it's not that bad for you. Actually, the book is about compassion. Compassion is about connecting with distress. Connecting with each other's distress, and having the motivation to alleviate it. And actually, when you start talking about this to other people, nobody said, oh, well, that's not that bad and not as bad as me or how can you talk about that or… Everybody is saying I get that. I've had part of that experience, or this was my experience, and this is what has helped me, or this is what I'm still struggling with, or this is what I need to think about more. And even the bits that I was really worried about sharing, like fertility as an example, I still gave up my fertility. I gave up the ability to have more children, I gave up what I had imagined my family would be like, I gave up a lot with the surgery decision that I made. I don't regret it, but it's still a part of the experience and we have to, I think as women with endometriosis or people with gynaecological issues, people who are struggling, I think we have to be able to embrace it all and accept it all. That's what's going to make the change.

Yeah. And I think It's so interesting because our society does seem to be built for this almost one upmanship of distress. So, you know, the classic example is, how tired are you? Oh, well, I'm more tired than you because I did this and I'm more tired than you because I did that. But actually, often if you create the sort of foundation for compassion where it's like, we're just not going to do that. You know, we're, we're not here to compare. We're here to, you know, acknowledge that your pain exists alongside my pain. And it, you know, one doesn't cancel out the other. People are so able to get into that mindset and benefit from that supportive environment. I often feel in group programs, that's one of the most important things that we can do as psychologists leading those programs to, you know, create that kind of different, compassionate way of communicating, which is often not there. And when you were talking about that, it just made me think, what about this experience for you do you think was different or changed, if you think it was, by your professional background, by being a clinical psychologist?

Well, the early part of my experience, obviously, I wasn't a clinical psychologist. So it's a relatively interesting journey in that sense, because I first had symptoms of endometriosis when I was about 12, and I qualified as a psychologist at 25 I think 26, something like that, but a long time after. So I think the early part of my experience obviously wasn't impacted at all and I'd already developed a load of coping strategies and safety strategies and ways of managing that probably weren't that helpful, weren't all that helpful. I think what it helped with being a psychologist later was the ability to go back and make sense of it all and understand why it happened and why it happened in that way, what it meant, and what it had led to, and what I would continue to carry from it, both good and bad. And I think it helped me to begin to recover from some of the trauma of it all. It also allowed me to access support for it. So it helped to reduce some of the shame I think that comes with accessing therapy, accessing other resources, speaking to people about what's going on. It helped me to bring some of that compassion in and say, it's okay that you experience this, you being able to share this is helpful, there will be somebody who might have a different experience, that's okay. It also helped me to navigate the really challenging bits, so like the surgery, having some skills to go into that surgery, be able to wait in the waiting room, be able to take the time for myself in the hospital, be able to bring myself home, all of those things. That did require skill, skills that are in the book, just to survive them. And I think that's the thing with endometriosis and probably any long term condition, is sometimes all you can do is survive. The book is all about skills and things you might learn. But there's never a time with endometriosis where you go, oh, now's a great time to learn some skills. Often in therapy, a psychologist will ask is it the right time for you to come to therapy? Is now the time? And as a patient, for me, that question was ridiculous because there was never going to be a time where I wasn't struggling with some part of my endometriosis experience. There wasn't a day where I wasn't in pain. There wasn't a month where I wasn't debilitated. There wasn't any, that just didn't happen. So you've got to learn to navigate it whilst it was happening, whilst you were on this never ending sort of circle of it all. And I think my professional experience helped me to do that, adapt it, manage it, break it down. I had repeated exposure to material that was going to be helpful. I could integrate it at my own pace. I could take bits that worked for me and leave the bits that didn't. So, you know, I was able to learn, like you say, you learn so much as a clinical psychologist. You're taught all different kinds of therapies. You're taught all different kinds of ideas. And I was able to pick the one that made the most sense to me and learn about that, and that I wouldn't have got that level of knowledge and that level of choice if I hadn't been a clinical psychologist, and that's why when I wrote the book, it's the approach that was helpful for me. Might not be the approach that's helpful for everybody, it might not be the one that's in the NICE guidance when they get to giving you some NICE guidance for psychological treatment for endometriosis, but it's the one that helped me.

I think it's really helpful. And it sounds like that overarching perspective of kind of getting how the system works and how stuff isn't always black and white, even when it is presented as such, as something I felt when I was struggling with hyperemesis you know, people might say to me, this is the best treatment and I would take that with a pinch of salt. You know, I'll go and do my own research and try and understand that because being in the system for long enough to know it's very unlikely that it's a hundred percent conclusive that that is the best treatment. And I think, you know, I can hear that kind of critical thinking and everything that you're describing there and thinking, you know, what's going to work for me here. And if we can pass that on to people through the way that you talk, through your book and interviews like this, I think that's so powerful because before I was a clinical psychologist, I did not have that. I was from the kind of background where the doctor tells you what to do and you go, yes, very clever person, I will do what you say. And so I think, you know, you shouldn't underestimate how powerful it is just to hear you talk in that way about how you decided what to do and made those decisions.

But it's because there is no best treatment for everybody. That is a myth. Complete and utter myth. What I want people to think about is what is best for you. Because what is best for you is not what is best for me, or the person next to me, or the person next to you, or anybody else. And actually sometimes what is best for you won't be what's best for the system. So for example, for myself, I was given the option to have a full hysterectomy, including removal of my ovaries. That was with one consultant through the NHS. And I didn't really want to lose my ovaries. But that particular consultant, that particular department, I would not have had a choice. It was the only option I was given, was to lose my womb, my cervix, my ovaries, my fallopian tubes, everything. And I wasn't sure I wanted to do that because if I had my ovaries removed, I would go into menopause, there's challenges with that. Obviously, I'd already had a chemical menopause through another form of treatment, I knew a bit what that was like. I wanted to know what the other options were and see if I could keep an ovary. And I knew there were risks with keeping an ovary in terms of it's more likely my endometriosis may come back, regrow. But I also knew it would keep me out of menopause. But I had to find a different consultant to have that conversation and somebody who was willing to retain or try to save my ovaries. I saved one, I call her Olive, Olive the lonely ovary because she's in there all by herself. You know, she does, she does what she's supposed to do, which is at the moment, keep me out of menopause for a bit longer. We all know the challenges that are faced with menopause at the moment. So, but I had to go to somebody else. And I, like you, I think there would have been a time where I would have said, oh, okay, if that's the only option, then I'll go with that. But you, you don't have to do that. And that's the biggest message, is you don't have to do that. You might have to have a bit of a battle to go to different people, but you can ask for different options. You can ask for alternatives. You can adapt things to suit yourself. You can take time to make a decision. You don't have to say, yes, that's fine. You can go, actually, I need to think about that. I need to read about that. I need to know more about that. I need another appointment to have another conversation about this because whatever decision you make, you live with that decision. I don't think it's helpful to go, was it right, wrong, because you don't know. When you go into it, you don't know. So you have to make the decision with the information you have at the time and hopefully, as you say, the psychologist in me is then being able to go back to why I made that decision, even if it didn't turn out the way I expected. Even if it didn't have the advantages that I'd hoped for. Why did I make that decision at that time? And I made the decisions along my journey always with a view to try and improve my own quality of life, my own well being, and to improve how I could be with my family. No, I wanted to be able to parent differently. I wanted to be able to sit down on the floor and play Lego and get back up again without help. I wanted to be able to walk around the park. I wanted to be able to go on holiday and not need a wheelchair. That's what I wanted and had that not happened then I still would have made the decision with that motivation in mind and I would have known that I had tried and had all the information and made the decision that I felt was best for me and for my family. It happened that it did turn out that way and I'm very grateful for that, but it's also an incurable condition so I don't know whether it will stay that way or not. But I think it's having that ability to both critique, like you're saying, have that critical state of mind, that ability to think. I think you have to be able to assert yourself, which is incredibly difficult in the system. You might need a lot of help and a lot of time to do that. And I think you have to be able to give yourself permission to advocate differently. Remember that you are worth more than you probably think you are some of the time.

It sounds like such a powerful message and I think the book is going to be so helpful for so many people. You know, only yesterday I was talking to somebody in my life who has just had surgery for endometriosis. It's the first I knew of it. I've known her for quite a while. I had no idea that she was struggling with that and it'd been so difficult for her to talk about. So I imagine that we all know somebody who's struggling and we might not know necessarily. So, yeah, thank you for sharing your message. I mean, very quickly before we go, do you have any advice to any other psychologists or therapists that might be, might have a story of their own that they'd like to write about, but might be struggling to figure out how to get started?

I think that's not an easy question to answer, actually. Do I have any advice? I would suggest that you get some support and talk, maybe talk to people that have done it. Maybe talk to people who, around you, who might be able to help you to do it. Clinical psychology and I think psychology in general, still, we still feel a bit, certainly I think a few of us in the authors group, still feel a bit like trailblazers in that it's not always the done thing to talk about your personal experience as a psychologist still feels a little bit new and a little bit anxiety provoking and a little bit threatening, sometimes quite a lot threatening actually. What helped me with that was having a network and I think Sarah spoke about this on your podcast as well, is having some people around that were doing the same thing, were going through the same thing and were motivated by the same thing. And I think being able to again, go back to a sense of why you've done it and why you're doing it, and making sure you're in the place to do that, like anybody sharing their lived experience, psychologist or non psychologist, it's an incredibly exposing process. For me at the moment, you know, the book is out, it's available for pre order, but the idea that people might buy it and read it is still something I'm not really engaging with, I'm just kind of assuming that maybe it's just kind of out there, I'm not thinking about it. And when I think about that, I feel anxious, you know, I don't know how it's going to be received. I'm sure there will be things in it that people don't agree with or don't resonate with their experience, or don't quite fit with them. There may be other therapists that would do it completely differently and don't like the approach, or there will be something that somebody doesn't like about it, and I've got to tolerate that. I can't change it, and it helps me to know why I did it, what the point of it was. I don't claim that it, to speak for everybody with endometriosis, I don't claim to speak for every clinical psychologist. I just wanted to put out there what my experience was, and if it's helpful, I'm pleased and if it isn't, that's okay too.

I think it's so challenging, the issue of self disclosure. I think it's really scary for a number of reasons, like as you picked up on, there is still judgement about it sometimes, because certainly I think we were probably training at about the same time. It was still an absolute no at that time. And I remember talking about it and saying, do you know what? I think it might be quite useful sometimes, I've been reading about acceptance and commitment therapy, for example, and being completely shot down, and by a lot of my peers as well, not necessarily the course tutors, but people around me being like, no, you shouldn't be a clinical psychologist if you've got issues like that, I was like, oh, okay, keep that to myself then. And actually. You know, having practised now, I feel completely the other end of the spectrum. I really feel strongly that we need to, you know, once we've got an understanding of something that we've been through, I think being able to share that is really powerful for all the reasons we've talked about today. And I'm so confident that your book and Yvonne's book and Sarah's book will make so much impact because of that, that ability to let somebody in and see the imperfect process that you've been through. I don't like this idea that people might look at a clinical psychologist and think that we've navigated all of our own struggles perfectly. I love the fact that you're talking about the fact that you debated these things and you weren't quite sure and you did this because on balance it felt right, because that's how our heads work. And there are people sitting at home thinking, I don't know and maybe I don't know because I'm not clever enough to make this decision or yeah. And I just think sharing the imperfection of the decision making process is so necessary.

Yeah. And I think also accepting you're not going to share it all. And I know when I started the book, I ummed and aahed, you know, what do I put in? What don't I put in? There's so much of my journey that isn't in there that probably could have been. It's been edited. Some of it's been edited because I don't want to share that publicly. Some of it's been edited because it just doesn't fit with the flow of the book or it's not right for this part or whatever. And I think, again, you can get caught up in, have I misrepresented it, have I not been honest enough, am I withholding things? I don't think it's any of that. I think you're trying to create something that is for other people. This is for other people to read, and therefore what's in it, although it is my story, and it's my husband's story, and my family's story, it is edited with a view to make it helpful for somebody else's story. And there will be other things that will come out, I'm sure, in interviews like this, or through social media pages or other things that are not in the book. But that doesn't mean that you've misrepresented something, or if your experience changes, or your viewpoint changes, again there's that fear of like, oh, if I put it down on paper and then, you know, the research gets updated, or I change my opinion, or… That's okay. Whereas I think as psychologists, a lot of us are quite perfectionistic. A lot of us like things to be right, and we like to be sure of things. You know, we're still scientist practitioners, but we're scientist practitioners that deal in uncertainty, and I think that requires a whole sort of professional and personal journey to get to a point where you can manage that. I don't know if you, if that journey ever ends, I'm pretty sure it doesn't. I think it's sort of a lifetime commitment to evolve, but that's what this is about. It's about evolution. It's about taking information and going the next step and going further and trying to make things different all the time. And that's how things change.

I mean, what a powerful note to end on. Thank you so much. You've given us so much of your time today. And so I believe it's available for pre-order now. The book Coping with Endometriosis: Bringing Compassion to Pain, Shame and Uncertainty. So I'm going to put a link to that in the show notes. And I recommend that everybody goes and checks that out, of course. But where else can people find you if they want to connect with you after this?

So the best place to follow me is Instagram. so my Instagram is @Dr_K_Harris. So you're welcome to tag that. It's probably the easiest way for people to find me. That's what I'm using at the moment for updates and information.

Brilliant. So I'll share a link to that as well in the show notes. Thank you so much, Kirsty. It's been a real pleasure to talk to you today.

Thank you. Thanks very much.

And that's a wrap for this season of the Business of Psychology. I'm taking a little break to record some episodes and do some research for the next series, so I'll be back in your earbuds in the summer. But remember, I'm still here to support you. If you'd like support with a more than therapy project, I take on a small number of one to one coaching clients each month, and I'd be absolutely delighted to help you. You can book a free discovery call with me. Just follow the link in the show notes. If you're getting set up in private practice and you want to make sure you build a business that makes the impact and the income that you want to achieve, then come on over and take a look at my Start and Grow group coaching program. So take care and I will see you in the summer.