How to write a successful case report (with Annie Slater)

[00:00:00] Bronwyn: Hey, mental workers. Welcome back to the Mental Work Podcast, your companion to early career psychology hosted by me, Dr. Bronwyn Milkins.

[00:00:12] And today we are talking about case reports. Have you had to do a case report as part of your studies or as part of your registrar program? I have. I did the 5 plus 1 program and I think I had to do four case studies. And they were really hard. It was hard to know what to put in them, how to actually get onto them, beat the procrastination, and then get them passed.

[00:00:33] And even if you didn't do the 5 plus 1, you did the Master's pathway, I think you have to submit case studies as part of that as well. So in reality, all of us are going to have to write case reports. And so it's really good to know how we can manage them better. What good case reports look like, what are some hints and tips if you're struggling with your case reports and what leads case reports to fail? Because what you can get from APRHA if you're submitting to them is satisfactory or fail. So what's the difference? Here to help us out is our wonderful returning guest, Annie Slater. Hi, Annie.

[00:01:07] Annie: Hey Bronwyn, thanks for having me.

[00:01:09] Bronwyn: It's such a pleasure to have you back on. Listeners, you might remember Annie from a previous episode, which was on how to get the most out of supervision, which I found really helpful as well. And I'll pop that link in the show notes, but today Annie is case report extraordinaire. I'm just going to say that because you look at a lot of case reports.

[00:01:27] Annie: I do, but that's a, that's a troubling statement.

[00:01:33] Bronwyn: And before we get into that, Annie, could you just remind listeners who you are and I'll get you to say what your non psychology passion is as well.

[00:01:40] Annie: Yeah, so I'm Annie Slater. Um, I have two businesses. I've got Annie Slater Psychology where I do my private practice work, therapy and assessments. And then I also the director of the Provisional Psychologist Network, which was all about provisional psychology, the registrar program, all the things that people need to become registered.

[00:02:00] So yeah. And my non psychology passion would probably be, um, traveling and even creating travel itineraries that maybe I don't even end up doing. It's just like a passion. I'm just like, oh, we could do this. It's a very good way to dissociate, I think.

[00:02:18] Bronwyn: That sounds, yeah, that sounds pretty good, like a fantasy itinerary, even if you're not going to go there.

[00:02:23] Annie: Yeah, I have, it's a bit compulsive. Just like looking at really fancy hotels. Yeah, yeah.

[00:02:28] Bronwyn: I I hear that and I'm like, look, it's better than doom scrolling, you know?

[00:02:32] Annie: I guess it's a version of doom scrolling.

[00:02:37] Bronwyn: Um, what's your favorite place to travel to or favorite place that you have traveled to?

[00:02:41] Annie: Oh, so many. I think. Um, I love Switzerland. A lot of Bruin in Switzerland's. Probably, probably my favorite. If I had to pick one, it would be there anywhere kind of like Europe. I like that. So, mm.

[00:02:54] Bronwyn: Is there a place that you're itching to go to?

[00:02:57] Annie: I have a giant bucket list. Bronwyn . It's a real problem, but I'm, I think my next one will probably be the Maldives, 'cause I haven't been there yet. Mm-hmm mm-hmm.

[00:03:07] Bronwyn: Well, that would be awesome. Yeah. That's a future itinerary to craft.

[00:03:12] Annie: And help us through winter. See, it's like a bit of...

[00:03:16] Bronwyn: Yeah, absolutely. Yeah. Well, thank you, Annie, for sharing your non psychology passion with us. You're also a Board Approved Supervisor, right?

[00:03:25] Annie: Yes.

[00:03:26] Bronwyn: Yeah, I don't know if you said that. Maybe you said that and then I just imagined that you didn't. But anyway, you're a Board Approved Supervisor. Could you please tell us what you do in your role as a Supervisor of Provisional Psychologists?

[00:03:37] Annie: Yeah. Um, lots of different things, actually. We, um, Really just anything that's around increasing people's, like, competence in their eight competencies for psychological practice. So, individual supervision, group supervision, professional development, case report reviews. I do a lot of case report reviews. Um, and I actually do lots of supervision of supervision now, which is, um, which is nice. So, yeah, just all the things related to that.

[00:04:05] Bronwyn: Yeah. And what prompted you to become a supervisor? Like, what do you like about it?

[00:04:09] Annie: I love that question. Um, I, I had some really like helpful and unhelpful experiences and I think we've all had that in supervision. Um, and I, I did the 4 plus 2 back before all of the kind of more recent services had popped up around helping with the NPE. Like all of the services now, they didn't really exist when I did my 4 plus 2. I don't know if you were the same with your 5 plus 1.

[00:04:35] Bronwyn: Yeah.

[00:04:36] Annie: Yeah, yeah, And I just remember thinking like, Why has no one actually helped more provisionals in learning these things? It's almost like you had to teach yourself. Um, and I was really passionate that that shouldn't be the case because I don't know if you were the same, like having just to read the, you know, WISC manual and working it out on your own. And it just, it's just not, it just was not good. So I just wanted it to be better.

[00:05:00] Bronwyn: I was I was literally thinking of the WISC manual plus reading the 5 plus 1 guidelines, which is like a 30, 40 page document. And anytime I had to, like, I pretty much memorized these freaking guidelines for the 5 plus 1 program.

[00:05:12] Annie: Yeah, oh, and as a supervisor, I have to keep going back to them, and they're so long that sometimes you're like, you question yourself, you're like, I'm sure that's the rule, and I know it's the rule, but I still have to go back and scroll, doom scroll through this guideline ...

[00:05:23] Bronwyn: yeah.

[00:05:24] Annie: ...to find it...

[00:05:25] Bronwyn: It is. It's a cursed document.

[00:05:28] Annie: And the 4 plus 2 is worse, like I think it's double the amount of documentation.

[00:05:32] Bronwyn: It is. Absolutely. So it really came out of a passion to ensure that people had the support maybe that you didn't quite have.

[00:05:38] Annie: Yeah, yeah, and I loved, um, uh, teaching. So I've got, I'm also teacher trained. So that's, yeah, so the two go together, I think.

[00:05:46] Bronwyn: Oh, absolutely. Yeah, what a fantastic combination.

[00:05:50] Okay, so when you say that you've read a lot of case reports, how many case reports do you reckon you've edited?

[00:05:56] Annie: My gosh, that's funny. Um, I was trying to work this out because I had the prep questions. And I, it's, it's hilarious. I probably do about five a week. And I actually, because I do, we have a team of supervisors. whenever they have a, a, a case report that they kind of go, Oh, I need a second review just to kind of check if I'm, if it's on point. I do theirs as well. So I reckon in the time that I've been board approved, I've probably done close to a thousand.

[00:06:22] Bronwyn: That's insane.

[00:06:24] Annie: I know. And I only realized that when we put that on the questions and I was like, that is a lot, um, but you get really good at it and very quick and a lot more efficient. I think once you've read that many.

[00:06:36] Bronwyn: I feel like you should get a badge or a certificate or something like, has read a thousand case reports.

[00:06:42] Annie: I don't know. I don't know if it's good.

[00:06:43] Bronwyn: I don't I don't know if sad, but, but I guess like you'd be very experienced. So you'd know exactly, okay, this is on point. This is not on point.

[00:06:54] Annie: Yeah, absolutely. And um, you can really, when you've read that many, It's really clear if someone's done case report training or if they haven't. And yeah, and, and, and it just really speeds up the level of editing that you have to do. But, um, yeah, you can, you can tell also if it's their first case report or if it's their like, if it's four plus two, it's their eighth because you get better at them by the last one. I don't know if you had that experience too.

[00:07:20] Bronwyn: You do. Yep. No, I did. Yep.

[00:07:22] Annie: Yeah. It's funny.

[00:07:24] Bronwyn: Yeah. I'm just imagining you like getting to the point where you could be like, this person ate Weet Bix for breakfast and then wrote this case report. Like you could do a full depth psychological analysis on their state of mind and their frame and what they're doing.

[00:07:35] Annie: Now I want Weetbix.

[00:07:36] Bronwyn: Yeah.

[00:07:39] Okay. And let's, let's just ask like, why, why do we have to do this? Why do provisional psychologists have to complete case reports? Why is this even a thing?

[00:07:48] Annie: Yeah, I think, um, it's a great question because really it's one of the assessment tasks that allow us to demonstrate that we have those core competencies because as someone who edits them, it's really clear if someone has or hasn't got those competencies that they're assessing when you edit a case report, which makes complete sense because you're developing it, right, over the course of your internship. You don't know everything, particularly at the beginning.

[00:08:13] But really it is assessing a couple of like key things. So, it's assessing your ability to complete a semi structured interview through that lens of, and we may not all agree with it, and like, this definitely has issues with it, is that medical model, which is, um, here is a problem, a disorder, in inverted commas, what is the treatment we pair with it that is evidence based, um, and we treat it and then we reflect on, like, the outcome. Or even with that biosocial, psychosocial model as well, like really using that as a model for exploring kind of a client's problem.

[00:08:49] And then also if making sure that we can gather the symptoms to then link it to the appropriate diagnosis. And that we are using the appropriate assessment tools that are evidence based for that client in their age, in, you know, um, even just in thinking about like kind of their cultural background, if there's any individual differences. That then we can diagnose correctly, so we can look at the diagnostic criteria, identify if the client meets them or not, and justify that. Um, and then pick an appropriate treatment for that client based on the diagnosis and their presenting problem and their goals and then do the treatment. Um, and then reflect on it.

[00:09:28] So there's lots of things that we do in case reports. Um, and I think the trickiest thing about them honestly is the word count.

[00:09:37] Bronwyn: I agree 100%.

[00:09:40] Annie: I have, as a board approved supervisor, I have like this internal frustration every time I have to do an extra edit just because we have to get it under the word count. It just seems so, I get we have to be succinct and write professionally, but like, I feel really bad for people who work in dual diagnosis or they have clients with more complexity that require you to have more information to justify those things adequately and the word count is not enough. It's just not.

[00:10:07] Bronwyn: It's not. I, I remember, like, I've written this sentence, it's a perfect sentence. It conveys exactly what I wanted to convey. How can I cut three words off this sentence and then like having to rewrite sections just so I can have the same information, but shorter.

[00:10:22] Annie: Yeah, and then, but also, also making it sure that you're not cutting it so much that you haven't gone to, like, you haven't, um, you're writing a full sentence because you have to do that for your case report. Like, it's, it's a, it's a tricky thing. You do get better with certain things though. My hacks, real quick, because this is, take out "that".

[00:10:40] It's a useless word in usually most sentences. I think you probably found that when you did them. Yeah. Yeah. And, um, writing nil. Nil blah blah blah, whatever the end of the sentence is, because sometimes it's a much easier way of writing the sentence than a succinct way of writing the sentence, I should explain.

[00:11:00] Bronwyn: And that's handy hacks to, to have. Absolutely. But yeah, so I guess summarizing that it's a great way to demonstrate a lot of competencies that we require provisional psychs to have competence in.

[00:11:12] Annie: Yeah, and also too, I miss too, is like linking it to research and psychological theories. So, you know, there's so much literature out there and models that we use to conceptualise problems that inform, you know, our diagnosis and our formulation. The case report's really assessing your ability to go ahead and do that effectively. And, um, and reference. Yay for referencing. <Laughing>

[00:11:38] Bronwyn: One of my case studies that I submitted was on health anxiety and it really forced me to go read about like a key researcher in health anxiety... there is Paul Salkovskis. And so it forced me to go look up his model and integrate that with my client and work out whether they have, uh, ways of presenting that are consistent with that model. And then how would I link that to their treatment? And then how would I assess that? And there's the short health... and health anxiety inventory and stuff like that. And yeah, so it was helpful from that perspective. It really integrates all of that.

[00:12:10] Annie: Yeah, and I think that's, uh, and you learn a lot from them, like, I'm sure you had this experience when you did them too. I know I did and continued to do this, where you get your case report, you write it, and then your supervisor then gives you feedback on things in the formulation that you maybe missed or things that you hadn't really considered around safety behaviors or avoidance behavior, like those maintaining variables that, you know, we're still getting good at identifying for the formulation and the treatment plan. I think, um, it's such a good opportunity for learning, you know.

[00:12:41] Bronwyn: It is. It is a really good opportunity, but I guess like maybe from hearing you talk about that... it is a lot as well, like, it's, it's no wonder that folks might struggle with case reports because it's a lot to show and to demonstrate and you just have to do lots of learning and I'm kind of like dangling my hands in front of me to like emphasize that there's a lot. That's, that's all I say.

[00:13:04] Annie: It's overwhelming! Yeah, no, it is, right? And even just, like, writing. Because, you know, in your internship too, you're learning how to write professionally and even in your case reports that is a skill that you're still nailing. And so even I just find a lot of it comes down to sometimes to even just editing sentence structure and learning how to write something objectively, not with emotion, you know, all of those are skills that, you know, again, are getting tested with your case report but you get... develop them by getting feedback along the way, you know.

[00:13:34] Bronwyn: Yeah, absolutely. And you sometimes don't realise until you get feedback that some of the words you're using might be really emotion laden. Like I can't think of an example. Do you have an example of like an emotion laden? I don't know.

[00:13:45] Annie: I just did one. I literally was just writing a case report before I popped into this podcast. I was editing it. And what was theirs? Oh, let me, what was it? It was a good one. What was it? Oh, I forget. It was about, oh, the client was consumed with their worry like consume and I was like, it's not a professional way. It's an emotional little yeah, or even just using like descriptive language that is over emphasizes something or under emphasizes something is another common one Like it was awful or was it? You know, yeah.

[00:14:20] Bronwyn: Yeah, absolutely. Yeah. And okay. Well, let's ask then what skills does a provisional psychologist need before they start tackling the case reports?

[00:14:29] Annie: It's a, it's a tricky one, isn't it? Because, you know, we, we start our internship and we kind of, in some ways, a little bit do get thrown in the deep end with our client work. I think with case reports, the skills even throughout the whole internship that you're still developing, so you may not have nailed them all completely yet, and that's kind of the point, but you want to at least have some foundation of being able to conduct an initial assessment effectively, you need to be able to gather a really good background history that takes into account maybe those predisposing variables, but also to, um, anything related to the onset and course of the problem that also encapsulates kind of that background history.

[00:15:13] That you can, um, you understand, some of the diagnoses in the DSM, like especially, usually we do, and I know this is the reality of it, more often than not, if we're keeping it simple, we're usually going to do some depression or anxiety disorders because they're a lot easier to write a case report on.

[00:15:32] Bronwyn: Yep, I did both. So I did depression, health, anxiety, and I think like, yeah, similar diagnoses in, in those chapters.

[00:15:38] Annie: Yeah. And so if you, if you, you have some good knowledge around what the diagnostic criteria are across some of those key disorders, um, obviously you can still go and, you know, look up differentials. 'cause sometimes that's like the biggest key, and that's what you learn from the case report is like, why wasn't it this disorder then? If we, if we, if we think it's this one, um, that you can pick an appropriate assessment tool. So, again, like, you can find out, oh, what is an appropriate assessment tool for generalised anxiety disorder, you know? And then carry it out, interpret it, um, and score it, um, and then put it into the formulation.

[00:16:15] So I see, usually when we give our case reports, you absolutely can do case reports on different, um, like, uh, therapeutic models. So ACT, DBT, you can, you can. But it's much more simple if you keep it to CBT, and you do a CBT formulation. So, I would say if you've got your CBT formulation down pat and you're still working on that, you're going to have a good ability to probably start doing your case reports. with the support of your supervisor because they should be helping you the whole way through, not just like you come to supervision with your case report. It should be, I'm thinking of doing this case for a case report and you guys can talk about if it's a good case to do a case report, you know, because some of them aren't as... some of them are a bit more complex, some of our client presentations.

[00:17:04] Bronwyn: Yeah, and I totally get this because, yeah, there are some presentations which are just, one, they just wouldn't fit in the word count, and two, they're just not a great presentation when you're trying to demonstrate competence in these areas, because that's what you need to do. That's what the case reports are... is aiming to, uh, show I guess your coordinators, whoever you're assessing it to.

[00:17:24] Um, but I totally get that dilemma because I remember during my 5 plus 1, I would have presentations and I'd be like, Oh, I really want to do a deep dive into this presentation. It's really complex. And I just want to, you know, have a deep dive into it. But then I had to be like, look, that won't make a great case report.

[00:17:41] Annie: Hmm.

[00:17:42] Bronwyn: I, when you said CBT, both my case reports were CBT.

[00:17:45] Annie: Yeah, yeah, and, and, and again, and most people, and I have this with my own primary supervisees all the time, I did it myself. More often than not, when someone does their first case report, if they haven't checked in, because it's really interesting, they'll pick the client with complex needs because they want to understand it, which is a really great, still bring it, still bring it to supervision, but that's going to be the supervisor assessed clients, not the ones we send to APRHA.

[00:18:10] Bronwyn: Yes.

[00:18:11] Annie: Um, just to make it a little bit more simple in terms of meeting that, because it's just the word count. It's not, it's not workable to do it on a really complex client, like a client with complex needs. It's just not when you've got multiple comorbidities, it's, it's, it's hard enough to do it with a client that is, um, a single presentation, you know, it's hard.

[00:18:32] Bronwyn: So when we're talking about any considerations for client presentations, it sounds like your recommendation is, uh, less complex, the better.

[00:18:41] Annie: Yes. Yes.

[00:18:42] Bronwyn: Okay.

[00:18:43] Annie: Keep it simple silly is my, is my mantra. So, where possible, not a client with comorbidities. I feel for supervisors who are in workplaces where all of their clients have dual diagnosis because it makes it really hard, makes it really hard.

[00:18:58] For those people, I, I recommend almost in some ways parking one of them. So in the background history you put what the other disorder is and you just focus on the other one. You still have to integrate it, but it allows you to be like, that was existing. That was pre existing where you can.

[00:19:15] I would also pick a client, hopefully, where there isn't a lot of risk, because again, it adds words. It's not that you wouldn't have done a good job or you couldn't rule out that risk effectively, but where there is, you have to demonstrate that you managed it, not just in the risk section, but also in the treatment plan. And so, um, it's more risk of maybe hitting some more of those critical areas that might lead to a fail.

[00:19:37] What else? Um, a client that generally is well motivated, has good insight, that you've got good rapport with, just because it, you know, you can still write a case report for intervention where the, uh, intervention wasn't effective. You actually can. It's just more about having to justify it, and it all just kind of comes down to that word count. It's going to be easier for your validity of your assessment too if you have a client that you have good engagement with, and you're pretty, you're pretty certain about your conclusions because you have good rapport. Um, yeah.

[00:20:06] What else? What do you think? Is there anything else that?

[00:20:08] Bronwyn: Well, just on that, like clients who are motivated and you've got good rapport with, um, I relate to that because I remember writing a case report for one client and as I was writing the case report, there were a few questions that came up for me and I was like, huh, I don't actually have this information from the client's background or their history. And so I was able to ask the client and I was like, Hey, like, you know, I think I might've missed this. And I think it's important for us to understand, like ask the questions, get the answers. And I'm like, thank you. Um, and that'll help me integrate that into treatment for you. And it's good for me to know as well. And they were able to readily provide me with that info because, um, they had that capacity.

[00:20:43] Annie: Yeah, yeah. And again, not all supervisors are going to work in areas where they have those clients, which I feel really, I feel for them, because APRHA kind of makes the assumption almost that you're not going to have the complexity when you're in your, that's not reality because all the jobs usually are available in the areas where we're working with clients with complex needs, or more likely to, right?

[00:21:04] Bronwyn: Yeah, absolutely.

[00:21:05] Annie: Yeah, it's hard. And I think the other thing too is just being really mindful when they're picking clients is that for the case reports, you know, for the five plus one where you only have to do four, it's a little bit easier. But for four plus twos, they have to pick eight different diagnoses. So you have to be, yeah, so you have to be really intentional around when you are picking... which diagnoses you're doing for which client. If that makes sense.

[00:21:29] So yeah, cause you might have a client and you know, yeah, you can't do generalised anxiety twice. So, you know, um, you know, really getting good at kind of noticing your client list and being like, Oh, I haven't worked with this yet. This is a case report. I have a case report client. I need to

[00:21:46] Bronwyn: Yeah.

[00:21:47] Annie: Yeah.

[00:21:48] Bronwyn: Hmm. And so when we're talking about submitting to APRHA, is failing common?

[00:21:53] Annie: I don't know. I don't, I don't think failing is very common. I think, um, I think there are some reasons why there might end up being more likely to be a fail. Unfortunately, I've had a few, because of my experience in the network and having lots of supervisees, just come in for case report reviews, there seems to be a pattern because this is the role of the supervisor. It's the supervisor's role to read and review the edit to make sure that it's met the standard and that we don't submit a case report if it has critical errors or... and kind of editing it and supporting them to choose another case, right?

[00:22:31] But some supervisors haven't done formalized case report training. It's not in our board approved supervision training at all. I do lots of supervision with supervisors to help them learn the skills on how to write a case report and it's a skill for us too, right? We could be an excellent clinician doesn't mean you can nail a case report.

[00:22:49] Bronwyn: Yep.

[00:22:49] Annie: What I would say there is, is sometimes I've had supervisees who failed two.

[00:22:54] Bronwyn: Oh, that's sad.

[00:22:55] Annie: And they've got like, not my ones that I've reviewed, but they come in and it's quite clear their supervisor maybe doesn't have the skill to edit it to the level that's required for APRHA. And so they just need someone else. So if you're, if supervisees are ever failing more than one, Like, one is kind of like, let's look at the feedback and see if we should have noticed that, if that was, that's a really obvious error that, like, stood out. Or, is this like a pattern, and actually maybe my supervisor doesn't necessarily have the skills because they shouldn't be submitting them to APRHA if they have critical errors. We should be able to identify them.

[00:23:31] Bronwyn: That makes sense. Are there any common areas or reasons you've seen that people fail?

[00:23:36] Annie: Um, yes. So the, and the, um, APRHA have some really good guidelines on what is a critical error. So when you look in the, they have like for each of the pathways, There's um, a summary, it's even got things like on how to choose a case report.

[00:23:52] Bronwyn: Oh wow. Oh gosh.

[00:23:53] Annie: Right now. Yeah, yeah, most people like avoid kind of the giant guidelines, right, because they're a bit of a, they're a bit boring. Um, but they have actually um, a discussion of what is a critical error in the guidelines. Um, and when I review a case report, like, these things stick out quite clearly. And so there are things like, um, really poor English expression and too many grammatical errors. Um, now, I don't think... I've never had an experience where a supervisor has failed just on that. But it's something to consider when you're reviewing it.

[00:24:27] Um, plagiarism. That has come up before, where people have just don't play it, that's a good rule, like Code of Ethics, just don't do that. Especially if you're using someone else's example. Lots of case report trainings have, like mine does, has examples of case reports. They are examples, they are not to use as a template. Do you know what I mean? So, Okay.

[00:24:47] Bronwyn: I mean you, you know, and you really, um, don't get the learning if you're plagiarising as well.

[00:24:53] Annie: No, not at all. Like, as a template, it's different to like, using it completely. Do you know what I mean? Yeah, 100%.

[00:24:58] If you, the other critical errors are things like, if you fail to do a risk assessment and, or the risk assessment isn't clear and doesn't manage the risk effectively. So say for instance, a client has disclosed in the background history or current problem that there is like, family violence at home, say for instance, and it's a child and we've got to the risk section and we've ignored that the need, there may be a need for mandatory report and we've just ignored it. That's like an ethical issue that would be flagged and it would be an automatic fail because we haven't met the standard because that's what the case report's just testing, the standard. And it's a pretty high standard but we should have a high standard because we're talking about client care and you know, you're wanting to hit the kind of good standard.

[00:25:39] Bronwyn: Yeah.

[00:25:40] Annie: Um, if you have used or interpreted any of the psychological tests incorrectly, um, or described them inappropriately or used one inappropriately. So say for instance, a client comes in and they were just describing this pattern of depression and you pick this random screener that has nothing to do with the client's presenting problem. It's going to fail because like what was the rationale for that? You're not integrating it effectively.

[00:26:06] Any interventions, so say for instance you've got a diagnosis and then you pick a treatment that is just not evidence based for that presentation or doesn't take into account the individual client. So say for instance it's a client with, um, you know, cultural differences and we have not even slightly considered how we might modify our intervention or how we might think differently about that client in their formulation given that cultural difference. That's likely to be a fail.

[00:26:36] What else? Um, not using a diagnostic system would probably be another one. Um, what else?

[00:26:43] Bronwyn: I've seen somebody, like when I was doing my case reports, um, I've seen somebody fail for the differential diagnosis section, so they didn't justify why they didn't meet these criteria and they didn't consider enough alternative diagnoses.

[00:26:59] Annie: Yeah, that is a really good one. Um, and I, you notice that when, as a marker. So what happens is if I read a case report, this is probably a really good feedback. If I read a case report, I should be able to tell by the background, if not the symptom section, what diagnoses this is.

[00:27:15] Bronwyn: Yeah.

[00:27:15] Annie: And so if I get to differentials and there's these weird symptoms that have been described in the other sections that may allude to other differentials, the real common ones are things like irritability that come across lots of different disorders, and then I have completely failed to even talk about, like, the other disorders that were that... little symptom we've definitely assessed and it was in the DASS or whatever. I've ignored it. That is a really good, um, that is a real common critical error.

[00:27:42] Um, and, and that also takes, and this isn't a probably another one that I notice is a marker, is ignoring I'll have a case report and, and I get why people do this because they're trying to keep it simple for themselves and I'm reading it and it sounds exactly like this client has ADHD or undiagnosed autism and they're coding the appropriate diagnosis that's probably comorbid but have missed all the things in the presenting problem that this client also may be neurodivergent. That's probably another one that I, that really stands out when I edit a case report. So, yeah.

[00:28:17] Bronwyn: this makes me think, like, do you know who marks these reports at APRHA? Like, are they, like, yeah, do you, do you know?

[00:28:25] Annie: It's a great question. It would be other psychologists. I would imagine there's like, psychologist offices at APRHA. I don't know any of them. I'm I'm tempted. This, this came up to me when I was preparing for our podcast, Bronwyn, because I was like, how do you get that job?

[00:28:39] Bronwyn: Well, that's what I was thinking. That's what I was thinking. I was like, where are these secret job ads for psychologists who mark APRHA reports? Like, is it internal hires? Wow. This is just like opened up like a deep, like dark, like vacuum for me to Google on.

[00:28:55] Annie: But they, they are very on point. So whenever I've read, because I get to, when someone fails, usually they bring it to me and we have a quick read and a second review. Like, there has never been a time where I have reviewed APRHA's feedback about the Case Report and disagreed. Like, it's always been like, yeah, that's right. Why did we miss this? Who, who missed this in, in, in reviewing it? Um.

[00:29:16] Bronwyn: If, if the person who marks the case reports is listening to this podcast, can you send me an email? Um, I just...

[00:29:21] Annie: How many they've edited, or reviewed?

[00:29:25] Bronwyn: They're like the grand boss of case reports. Like, yeah, I want to, I want to meet that person.

[00:29:29] Um, anyway, um, so there are two types of case reports. There's an assessment case report. There's an intervention case report. What's the difference?

[00:29:38] Annie: So, in some ways they're the same but different. So, the harder case report to write, in my opinion, and again it comes down to word count, is the intervention ones. And the reason for that, and this is, actually we should clarify too, our whole conversation so far have been dictated around like the 5 plus 1 and 4 plus 2 case reports because they are very, very, very different for the registrar programs.

[00:30:03] Yeah, because I did, I've done them too, just having completed my master's. They're much more like literature based and less like therapeutic based is in my opinion. Yeah, but for the ones for APRHA, so with the intervention ones, they are the same. So you still have to do reason for referral, presenting problem, background history, symptoms diagnosis for both the assessment and the intervention ones.

[00:30:28] But they become different after the diagnosis section, uh, depend, like, obviously if it's assessment or intervention. So, for both the assessment and intervention, you still have to have done the assessment. You still have to have come to a conclusion, or there have been a diagnosis or a problem for you to actually do the intervention treatment on.

[00:30:46] So, really the difference is, is when you get to the treatment ones, is that you, instead of, with the intervention ones, you're talking about. The treatment plan that you created for the client that you assessed, um, and then you carry out that treatment, reflect on it, um, think about how you implemented that intervention strategy and talk about the client's, um, outcomes in terms of, um, your treatment goals. And then you have to come up with a prognosis for the treatment one. The assessment one is a little bit different and it's much easier. It's much easier to stay within the word count for the assessment ones. How did you have that?

[00:31:25] Bronwyn: Yeah, cause, cause you just have to propose the treatment, right?

[00:31:29] Annie: Yes, exactly. It's, it's not what I did. It's like, based on my assessments, this is what we would recommend for this client. And then we just do a reflection of the validity and reliability and differentials, how we ruled out the differentials really in the, in the assessment section. So the intervention ones are harder to write. So I would, I say to my supervisor, start with your assessment ones.

[00:31:50] Bronwyn: That's a good hint.

[00:31:52] Annie: Because, yeah, if you can do that, you'll be better placed to then move on to your treatment ones, you know, because it is tricky to keep it within the word count, especially if your treatment was longer or it was a client with um, like several goals. Um, it's, it's hard.

[00:32:08] Bronwyn: Yeah, I don't... You know, it's, it's Like I was fortunate in air quotes because when I was doing my internship, I was mainly working within a public health service where clients had up to six sessions. So it was only, so it was only six sessions. That was great for treatment case studies because I only had to write about six sessions and yeah, that was, that was good. And then terminate treatment and I had to plan for six sessions and I could say, this is a six session service. I imagine it's much harder for other. Um, folks who are working within different services where the sessions are endless.

[00:32:41] Annie: Yeah, and I sometimes think too, it's, it's sometimes hard too, to do it with the short session plan. Because like, if you have someone and we look at the evidence base for like, Oh, I'm going to treat this. The evidence base is like, well, actually you need 20 sessions, but I've only got six. So how do I modify this to the appropriate, pick the appropriate things that are the priority, knowing I only have six and being able to justify that effectively, and then have an outcome.

[00:33:07] Bronwyn: I think I emphasize like continuity of care and be like we're going to provide the first service to address these goals and then the client will be referred on to other services to address their other goals.

[00:33:17] Annie: Yeah, perfect. And that's what you do in your prognosis section. Like, does this client need further treatment? Yes, because I only had, I only had six sessions. Yes.

[00:33:26] Bronwyn: Yep. Um, but yeah, it's pretty tricky. I guess we've talked about problems that you see as a, as a supervisor in case reports, what are some tips for completing a case report?

[00:33:38] Annie: Oh, um, okay. So my, I have lots of tips. So my first one would be that you are taking your initial assessments that you do with clients, that first one to two sessions where you're doing your formulation and you are coming up with a bit of a diagnostic hypothesis and treatment plan. Take that to supervision to see if there's anything that you missed for your supervisor to help you determine if this is going to be a case report client.

[00:34:08] Like if this is something that... um, use your supervisor. That's what they're for. I think a lot of people they come at the end and then the supervisor's like, because you know we have limited time in supervision, they come at the end and you're like, oh I wish you hadn't picked that assessment, oh I wish we'd done this, do you know what I mean?

[00:34:24] Bronwyn: Yeah. No, that was totally me. I literally like the way I use my supervisor and it's like embarrassing, but it was like, I said to my supervisor, Hey, I'm thinking of doing a case study on depression with this client. Supervisor. Yep, that sounds good. Okay. Writes whole thing, then returns to supervisor. It's probably not the best approach. Like, I was lucky that I didn't have, like, glaring, like, oversights, but it's, it's, you know, that was lucky.

[00:34:48] Annie: Yeah, oh and I think that's experience too, and also I think, I often say to my supervisees like, where we're unsure, because as someone who edits them, like you can put information. And later in the case report, because you've only written some of it and bring it to supervision, and it seems like something versus when you've written the whole thing, because it integrates differently when you start to add more symptoms if that makes sense.

[00:35:13] So what I often say is, is maybe write the presenting problem, the background history and the symptoms for us to then work that out before you keep going down the rabbit hole of, is this going to be a good case report? Because at those levels, if you've done some assessment, a supervisor should be able to talk you through if this is going to be a good fit, because you'll be able to hear very quickly like, Ooh, we've got comorbidity. That's actually comorbid. Not, not a single problem.

[00:35:40] Um, what else would be my tips? Oh, is my other tip, which a lot of people miss. So there are actual checklists that APRHA have written and you're actually meant to tick them off and then send it with your case report. Um, so that you follow and make sure that you've like nailed the right information in each section, because that is what APRHA uses to mark you is actually the checklist.

[00:36:04] So on our website, we have like a template that has the checklist embedded so that you can just delete it as you're writing it. It's just an easier way. So if people want to download that, they can. It's free on the website, so that's fine.

[00:36:17] Bronwyn: Yeah, and I was, um, I was telling Annie before we started the episode that I went into my 5 Plus 1 case study folders and I found these checklists in there and I couldn't remember them, but I'd used them, I'd completed them, um, and I was shocked, I was like, oh, wow, this is really handy. Nice one.

[00:36:33] Annie: I love, I think they must have so many people like just not follow the checklist. Like, and I know I get some, some case reports sometimes and they, they're like the old, like there was, there's been changes to the case report format over time. So some of the things that we had, like they used to call the observation section MSE, like there's been some changes and you can pick up when someone's used an old version of the checklist, um, very quickly. So definitely use the current up to date one, would be my advice, because it will save you time.

[00:37:03] Uh, what other tips? Do a case report training. That's, it's a skill, would be my advice.

[00:37:10] Bronwyn: I wish I'd done a case report training instead of like just trudging through on my own. I should have done it. I don't, well actually I didn't do it because none were available when I was doing mine. So-

[00:37:18] Annie: Me either. Like, we figured it

[00:37:21] Bronwyn: I would have loved to have done one though.

[00:37:24] Annie: Yeah, and they're not long. Usually like, you know, there's heaps of different providers out there who provide the training and they'll show you an example and I think seeing a case report that's passable and you can actually look at what it looks like and what the content is. It really helps you kind of write your own, um, and will save you a lot of time.

[00:37:42] Like, it's really clear to me when I get a case report to edit, if someone has or hasn't done a case report training. And, you know, if you think about how much it costs you to have a supervisor review one of your, um, case reports, it will 100 percent save you money because the case report trainings, most of them range probably for about $100. You're paying your supervisor per hour. It'll easily cut you down an hour of supervision if you've got a good template and you understand how to put what into what section.

[00:38:10] Bronwyn: I mean, I think it would just have helped me feel more confident, because the way that I did it was I sought out textbook chapters, and so I read them, and then I just tried to do my best with that. But like, I kind of didn't know what I was doing. Um, just, you know, tried hard, but yeah, I would have felt more confident if I had the training.

[00:38:30] Annie: Yeah, I still remember going to my supervisor with my first case report edit and just being terrified because I was like, I don't even know if this has hit the standard and I don't even know my treatment plan's okay and it was fine. But um, yeah, I'm glad we can take that anxiety out because I think some of that sometimes too generates people's procrastination with the case reports whereas if you know what to do and you've been reassured it's going to be okay it can kind of help with that stuff.

[00:38:55] So, uh, what else? There's a literature review by the APS that I share with all of my, um, supervisees that's also super helpful in justifying evidence based treatment, because that's what APRHA is looking for. So if you, and if, if listeners just Google APS literature review evidence based practice, it will pop up. It is this giant document with a whole bunch of references around the literature base for different treatments and the evidence that they

[00:39:21] Bronwyn: Yep. I've seen it. I know I've got it saved, so I know what it is. I'm pretty sure it has like a pink cover.

[00:39:26] Annie: It does, I think they've changed, it was purple, I think they've got a new one. So, I can't remember exactly the year, but Google, the new one will come up. Thank you, thank you for that APS literature review, it's very helpful. We can just say that's the level and the evidence base, so that's a win.

[00:39:43] What else would be my tips? Read out your case report out loud. I know, because what happens is I edit so many and we all do this. It's a common bias. You spend so much time reading and rewriting that case report, you cannot see the grammatical errors. Like, you just, it's so true and we all do it. And, um, so what I would say is read it out grammatically. Like, like with your, like the full stops and the commas and making sure that it actually sounds what you wrote.

[00:40:10] Bronwyn: Yes. Oh my God. I'm like shaking my head in frustration because my dad a few years ago went back to do some further study. And because I'm, you know, I've got, I've got a few degrees and stuff, he was like, Bronwyn, can you edit my stuff? And I was like, of course, dad, I will help. And eventually it led me to being like, refusing to read my dad's work unless he had promised me that he had read it out loud. And I was like, did you read it out loud? Because there were so many missing words, like the and of and like everything else. And I was like, Dad. So yes, I...

[00:40:43] Annie: I don't know if you had this experience, but I don't, I think when I did my 4plus2, I don't think my writing style was amazing, but I have to edit so many, like poor writing that you get really improves your writing. So, you know, future goals people, if you find someone that you're someone who has difficulties with their sentence structure, offer to read other people's because it actually can start to really demonstrate for you the issues with sentence structure and expression and you know, I definitely think that can help if you start editing others.

[00:41:16] And then start early. They take longer than people anticipate to write. Even just the reviews with your supervisor, like the back and forth that can kind of occur. Um, I think just planning, being realistic from how long it will take. Because lots of supervisees, because they procrastinate, you know, for lots of different reasons, might leave them to the end, and then it's like this rush to get it done, and um, you know, um, and so yeah, if you can, if you're listening, any time to start is better than not starting.

[00:41:47] Bronwyn: I totally underestimated how much time it would take to write the case reports. And I was like, it would take a month. And that was me like trying to be generous to myself. I was like, you know, it would take a month. It took like three or four months at least.

[00:42:00] Annie: Yeah, yeah, yeah, about a month of case report, probably, depending on how much time you have outside to do the second edit, the third edit, if it needs to happen, you know, um, which can go back and forth too.

[00:42:13] Bronwyn: Okay. Any other tips or tricks.

[00:42:15] Annie: I think, I think, I think they're the big, they're the big ones. I think they're the, they're the, probably the biggest tips is just, just making sure your supervisor is, is good with case reports. Because, um, The other thing too is making sure your supervisor is competent in the thing that you're reviewing for your case report, right?

[00:42:33] So I review lots of case reports. There's some presenting problems or assessments I won't touch because I'm not competent to tell you if you did it right or wrong, right? Um, not all supervisors have those skills so just making sure, you know, that that's their area of competence and if not get a secondary supervisor to look at it.

[00:42:48] Bronwyn: Yeah. So if your supervisor is not competent in the assessments or treatments that you want to write about, would you suggest that the supervisor say, I'm going to find somebody else or should the supervisee try and seek out other people and how would they do that?

[00:43:04] Annie: A good question. I think, um, I think it's a team effort to be honest. Like if my supervi, if I had something, one my supervisee, I would hope that I had already assessed that they, if they were doing something that, like working in practice, doing things that I'd couldn't support them with, that I'd already got them a secondary supervisor who was skilled in that area because, really, supervisees shouldn't be really working unless they have adequate supervision in the thing that they need. Um, so really it should have been addressed when they looked at kind of adding a job or, you know, discussing that in supervision.

[00:43:37] But I would say it's a team effort. I, if I have a supervisee and they bring something and I'm like, Oh, this isn't my area of super expertise... I'll either refer it to someone in my team to have a look at, like, and we do it from secondary supervision, but the primary still has to sign off on it, even if, which is the reality of it, but supervisors understand that. It's just, it's just the reality.

[00:43:58] Bronwyn: Yeah. Okay, cool. so are there any specific resources that you would suggest for case reports that you found handy or you've recommended them to your supervisees?

[00:44:08] Annie: Yeah, we were talking about this before we started recording. We were like, yeah, that one, that one. Um, so and we were like, how do you say his name? We don't know. Leahy

[00:44:17] Bronwyn: I just say Leighy.

[00:44:18] Annie: At all. Yeah, yeah. So, oh, I don't know if we can add it like a little thing on the podcast below and I can maybe link it, but so there's treatment plans and interventions for depression and anxiety disorders.

[00:44:30] Um, so that's Leahy 2012 et al. APA reference there, . Um, it's really good because you're probably going to be doing a depression or anxiety disorder and it's really good at demonstrating the assessments that are appropriate for each of the disorders. How you rule out differentials, what is the formulation? 'cause you need to know each of the formulations for the disorders. And that's so important to be able to integrate all that into your case report. And then what's the treatment? What do we, what is each of the, it's not, it's not just CBT. There are so many different interventions in CBT that you need to be aware that match to the treatment.

[00:45:04] So it's a really good book. I think I still use mine. I've-

[00:45:06] Bronwyn: Yeah, I still refer to it. Yeah, yeah, I do. Um, yeah, so I would read, I would take that as my starting point and I'd read that chapter and then I would feel much better and much more informed about what I'm doing. And it would also have references that I could look up. So even though it's from 2012, like something that I do is that I'll grab the say 2012 reference and then when you Google it, it has like cited by, and then you can see more recent research that has cited it and you can get eventually to review or something.

[00:45:35] Annie: Yeah. And I think they might have, cause this was from, I pulled these resources from my case report training. I think there might be an updated one. So, because this was from like, obviously when I did it, so it's probably, it's like, but I know they have, they, there's probably a new addition. 'cause that's the second ed. I'm pretty sure there'd be a new Ed.

[00:45:52] Bronwyn: I'll look it up. I'll put it in the show notes.

[00:45:54] Annie: All right, cool. Go Google it. Awesome. And then the other one that I would say, and it's for similar reasons and I was, this was actually a textbook from, in my master's course. And I hadn't used it before, but I'm really glad that I purchased it. It's a bit more in the pricey range for textbooks. You know how like you can buy some and they're like 30, 40 and then you buy some and you're like, Oh my gosh, this is an investment. Um, this is one of those investment ones. I think, I think it's about 150, I think, but it's something that is very good in terms of the literature and good for practice.

[00:46:28] So it's called the Handbook of Adult Clinical Psychology and evidence based practice approach. There's a child version and an adult version. So, Karen McNulty is the, or the authors. And the reason I like it, the adult one is broken down into the different clusters of disorders in the DSM. So it's got, it'll have like a section on psychotic disorders, it'll have a section on, um, depression disorders, it'll have, um, and in there it has all the things around which assessments for which disorders, for which treatment and the formulas.

[00:47:00] Yeah, super handy. Um, and it's got a couple of other really good sections too around like, um, how to write really well. Like, there's some extra things in that book that I think are really effective, but mostly for the formulation and the references. I think it's a good, it's good, it's a good textbook to have.

[00:47:18] Um, what else? The DSM would be another one, obviously. And actually read it. I have heaps of supervisees who... we'd go through their case report and we'd have a conversation about it and like, we'd talk about the differentials. And I really encourage them to go and actually read that diagnosis and all of the extra literature that is in the DSM. Because you know how we had the diagnostic criteria and then it has...

[00:47:40] Bronwyn: yeah. It has like the description and like...

[00:47:42] Annie: yes! Yes! Yes! Yeah! Oh, that's a really good point really to quickly just segue back to. We don't have to in our case reports do all of the differentials that are under each of the disorder. It's, it's just the ones that are justified by the symptoms.

[00:47:58] So, you know, you don't have to, um, just are not, you don't have to justify that it's not a differential if it's in the DSM. It's more that is the symptom justifying the need to rule out the differential. So, um, and get the current version of the DSM, which I think if supervisees want to save like if it's budget's an issue.

[00:48:20] Yeah. um, and AAPI, I think once you've read it, yep.

[00:48:23] Bronwyn: You can get it for free through AAPI. Um, I, I prefer the online one actually because you know what, they actually do updates to it periodically. So they will put it on the online version and they'll be like, oh, this has been updated and you can click on it and then they'll tell you the little update. But I also do a lot of control F to search for particular words and I find that very handy.

[00:48:45] Annie: I like that. You know what I do, and this is, this is probably not, well, maybe, I find this one, I don't know if you've seen this one, the little baby one.

[00:48:52] Bronwyn: I've seen that.

[00:48:53] Annie: This is, this is when I'm doing case report reviews on holidays because I don't want to take that giant textbook. People can't probably see but it's like the desk reference and it's this tiny like little cute DSM that just has the diagnostic criteria because that's all I need as the supervisor. So, um, yeah.

[00:49:12] Bronwyn: Yeah, on reading the DSM as well, you know how earlier you were talking about, like, you should be able to know from reading the presenting problem and the background, like, what this is, what diagnosis this is potentially leading to? I find that reading the DSM is really handy for that as well, because in, under the criteria, it will be, like, patients commonly present with XYZ, and then you can be like, Oh yes, my client, they're presenting with XYZ, so I can put that in my case report, because that's an obvious factor that goes along with depression, for example.

[00:49:43] Annie: Yeah, perfect. And or you're like, that doesn't sound like my client. Which one's my client? Oh, is this a trauma disorder? Oh, oh Yep Yeah, super helpful.

[00:49:54] And the other ones that I would just recommend just for like treatment planning because I think I don't necessarily as a clinician use these treatment plans because they're very very long and I don't and I but I think they're a good start for case reports if you're like what would be an appropriate evidence based treatment for this client and what would that session structure look like?

[00:50:15] It's good for case reports in that sense, but I'm, it's, you know, not super, my, not my favourite treatment planner, I guess I'd say, because the treatment plans are really, really long. Um, so it's called the, um, Complete Adult Psychotherapy Treatment Planner by, yeah, Jongsma. I don't know if you have that feeling too. I'm like, Who has 30, 40 sessions? But you look at it and go, okay, that's an evidence based sequence for this, how can I take that and really modify it for my client.

[00:50:44] Bronwyn: Yeah, and I can't remember if the Leahy one, Does that one have treatment plans as well? Because I remember there's a book, I can't remember which book it is, but there's one which had like short treatment plan and then super long treatment plan. Do you know what I'm talking about?

[00:50:58] Annie: Never, like, that would be very helpful. I just, I just, Google, I like that, Bronwyn, keep going.

[00:51:04] Bronwyn: Yeah. I'm just going to have a quick look at my, um, my folder actually.

[00:51:08] Annie: I love it.

[00:51:08] Bronwyn: One moment please.

[00:51:09] Annie: While you do that, I'll talk about NovoPsych, is that Um, NovoPsych is also an amazing resource. It used to be free. I've just realized I'm going to have to go back and modify my case report training because it's not free anymore. It used to be so good. We used to, um, NovoPsych is a, um, a software where we have lots of appropriate evidence based treatments, uh, assessments, should I say, based on different presenting problems that you can do online. So you can email it to the client or score it and send you back a report and you can use actually a lot of the references that NovoPsych have put in about the assessment, so it can be really helpful there, and it's just a massive time saver.

[00:51:48] Bronwyn: There is a student plan though.

[00:51:49] Annie: Oh, there is?

[00:51:51] Bronwyn: I think, I think the student plan might be free. Um, I think I'm currently on it because I'm studying the bridging program right now. So I was like, look, I'm not practicing this year. Can I please be on the student plan?

[00:52:02] Annie: I should have done that. Why didn't I do that?

[00:52:04] Bronwyn: I don't know. I don't know, Annie.

[00:52:09] Annie: That's so good.

[00:52:10] Bronwyn: Um, yeah. Um, but yeah, check it out there. And they're very responsive with, um, contacting them as well, I've found.

[00:52:16] Annie: That's good, yeah. And that you can do, you can, uh, track it over time, so you'll get this beautiful graph that you can put in your, um, GP letters. Snipping tool, there you go, that's how.

[00:52:26] Bronwyn: No, it's super handy. I just found this on treatment plan. It is from the Leahy book. So it's got, yeah, from treatment plans and interventions for depression and anxiety disorders, second edition. And it's got, I just picked up the one for generalized anxiety disorder and it's got general plan of treatment for generalized anxiety disorder. And it's, it's much shorter and it's literally got like assessment, socialization, relaxation, mindfulness, cognitive evaluation, interpersonal interventions, problem solving, facing out treatment.

[00:52:53] Annie: Love it. Love it. So good. So good. So good. Um, so I'm glad that we already recommended that one, see? Like, that's how good we are, bronwyn.

[00:53:01] Bronwyn: Yeah, wow. Ahead. Ahead of ourselves.

[00:53:06] Annie: But they would probably be my resource. Is there anything else you used during yours that you were like, Ooh, ooh.

[00:53:12] Bronwyn: Well, like it not specifically for case reports, but I'll just grab up the title so I can, let me see if I can find it. It's the Stritz, why do, why do people have surnames that I can't pronounce? Um, but it's the Stritzky one. Um, there's like, but let me just see if I can find it. Um, where would it be? Oh my gosh. I have so many things over the years that it's such a struggle to work out where I put things now. Let me see if I can find it.

[00:53:39] Okay, I've got it. So it's Clinical Psychology for Trainees and it's by Andrew Page and Werner Strzycki. Um, and they have a chapter, I believe, on case reports, which I found really helpful.

[00:53:52] Annie: I like that. Um, and while you were saying that, I was also thinking like the Center of Clinical Interventions, they have some really good, um, you know, links to kind of workbooks that are very manualized treatment for different presentations that you can use to kind of justify and work through a treatment plan with a client from a CBT perspective. So they can be quite good. And I think they've even got things now around DBT, IPT. I think they've got a few different things. It's not just CBT.

[00:54:18] Bronwyn: No. Yeah. And that's exactly what I did. So when I first started out, I would rely on the Center for Clinical Interventions a lot for their manualized treatments that they had, and they're all free. But for health anxiety, for instance, I followed their health anxiety module and they had references in the module as well. And they used a CBT slash metacognition approach. And, yeah, it was, it was really good. It was, it, it was really, um, anxiety relieving as a early career psych, um, to use those.

[00:54:49] Annie: Yeah, yeah, because it's really clear, and you actually learn a lot from those because they're very explicit. And so does the client, because then they can take it home.

[00:54:56] Bronwyn: Exactly. Exactly. Yeah. Okay. Well, the last thing that I wanted to ask you about, Annie, was that we talked, we, well, we mentioned earlier that some people get stuck in procrastination with case reports. How would you suggest that they overcome this?

[00:55:11] Annie: I, think most of us get, get caught in that procrastination. Like, I, I, I think, um, we're all human. And, um, I think we have to formulate the procrastination itself, because there's different, um, functions of procrastination, like some people are perfectionistic procrastinators, some people, like, everyone has their different kind of function for the procrastination,

[00:55:33] Bronwyn: There's a CCI module on that.

[00:55:35] Annie: Yeah, yeah, there you go, everyone, self therapy, there you go.

[00:55:39] Bronwyn: Yeah.

[00:55:40] Annie: Work through it. Um, some of the things I've recommended over time and it's different for everyone and, um, these are some things that I also did during my, some of them I did and some of them I didn't, but, um, and I've seen this on our Facebook group, like the Provisional Psych Facebook group, where people will set up, um, you know, kind of like body double support groups, where they're like, once a week, we're going to just do an hour of our case report together. We're just going to get online, and it's like non negotiable. We're just going to just be there, and it's just we have to do it. Um, I think they're really great.

[00:56:11] The way I kind of did it and I kind of try to support supervisees is sometimes the whole case report feels overwhelming. Like, I'm going to do the case report and it's the same as kind of when we work with clients and we just try to break it down into manageable chunks. Which is, how about we just start from reason for referral and that's due next week. And next week you can do the presenting problem section. You know, how many sections are there in a case report? I think, I think there's about, you know, 10 or something. By the time you've got through 10 weeks, you've written a case report, you know, or at least the draft. That can be a really helpful way.

[00:56:47] Some of the things that I used to do as a provisional, I love the Pomodoro technique. Like if I'm just, yeah, I just find that it's like, that seems achievable, I'm just going to do it for 20 minutes and then whatever, and then I just want to keep going, you know, which is, which can be really helpful. And I used to just bear it with rewards, to be honest. I'd be like, you're not, like, Annie, you're going to do your case report this Saturday and I'm going to do this much of it and if I get to the end then I'm allowed to go out and hang out with my friends. And then it's like, yes, I finished it. Yeah, I think there's lots of different ways you can navigate it.

[00:57:22] How did you find them? Did you, is there anything that you did when you had yours?

[00:57:26] Bronwyn: I kind of did them in different ways. There were a few that I just like, hyper focused my way through and I, like, completed the, like, a good draft within a week and I was just like, this is now my life. Um.

[00:57:41] Annie: Yep.

[00:57:42] Bronwyn: um, there were others that I completed, yeah, over a long time. The Pomodoro technique really does help me and I totally relate to, like, giving yourself rewards. So, it would be, like, and it'd also have to be the first thing that I do. So I wasn't allowed to like look at my emails or check social media or anything. If I did the case report for 25 minutes and then take a five minute break, you can look at it then and then you could get back to it. So it was a lot of self negotiation.

[00:58:07] Annie: Yeah. And I think too, when I did them too, it was just trying to work out when am I, am I the most cognitively functioning and not distracted because they actually take up a lot of brain space to write and, and thinking about your client and moving back and forth, even between the different sections. It's a lot.

[00:58:27] I've had some supervisees too that, you know, different times and that they've really benefited, benefited, um, from having some due dates. Because I think this is the tricky thing with the internship is it's like, this is what you have to do at some point during the internship. We would like you to have these done by the end. You can't finish till you get them done, but it's very flexible. And sometimes that flexibility for some people is-, isn't helpful. They actually need some like This is due next week and I'm, you know, accountable for that and I'm gonna, what do I need to do?

[00:58:59] Bronwyn: Yeah, exactly.

[00:59:00] Annie: Sometimes have that conversation with your supervisor too. 'cause sometimes it can be helpful just to have a due date.

[00:59:06] Bronwyn: No, I agree completely. And not be, and not shifting that due date, unless there is like a critical emergency that warrants shifting it.

[00:59:13] Annie: It's tricky. It's tricky too. And I think just like taking the pressure off like that it, I think if you're a perfectionistic, procrastinator is this like, it doesn't have to be perfect the first edit. Like it's not meant to be like just something . Yeah. Um, looking at our own CBT for our own thinking.

[00:59:31] Bronwyn: Yeah. Usually like my standard is it's readable and my supervisor's not going to be frustrated or look at me in pity if they read it.

[00:59:39] Annie: Yeah.

[00:59:40] Bronwyn: Yeah. Yeah. Like, oh no, Bronwyn really doesn't know what she's doing here. Like, so I'm like, okay, as long as I can anticipate that those things will be pretty all right, I'm all right with this.

[00:59:50] Annie: Yeah, yeah, I'm, I'm, I'm the supervisor that's A for effort. You did it and now we can like work on what needs to be improved. Because if you don't know, you don't know. That's why you don't know.

[00:59:59] Bronwyn: Yeah, you're, yeah, you're, dude, you're a prov psych. Like, you're learning.

[01:00:03] Annie: Yeah. Yeah. But you're like, you're right too. There's some accountability for like, we can Google treatment plans. You also can, you know, look into that ourselves too. So it's hard, but, um, yeah, I'm glad they're over for me. I won't lie. Like-

[01:00:18] Bronwyn: Me too.

[01:00:19] Annie: Like good luck everyone. And-

[01:00:21] Bronwyn: Yeah, it, it is a bit, but, um, yes, I'm, well, having, doing the bridging program right now, I've literally just had to finish like two more case reports. Um, yeah. And I was like, oh gosh, why?

[01:00:34] Annie: -different, right? To the AHPRA ones. They're really different. They're really different. And I did all the things I tell my supervisees not to do for mine. I picked like a trauma presentation, EMDR, I was like completely regretted it. I was like, why didn't I follow my own advice? Why? Why didn't I do that?

[01:00:51] Bronwyn: Yeah, totally. I, I picked like schema therapy and like some, yeah, just rare presentations and yeah.

[01:00:59] Annie: Don't be like us. Don't be like us. Keep it simple. Keep it simple. We'll get there.

[01:01:03] Bronwyn: -not as I do type thing.

[01:01:05] Annie: Yeah. 100%. Oh my goodness. But yeah. But I guess I'm now torturing myself because I edit them, but I actually really enjoy it. I actually really enjoy it, kind of the whole process. It's a, it's an interesting thing, even just the learning.

[01:01:17] Bronwyn: Yeah. No, absolutely.

[01:01:20] Well, Annie, is there a top thing that you want listeners to take away from our conversation today?

[01:01:25] Annie: Oh, that's a good question. Top thing. Checklists, use the checklist from AHPRA and if you can, because I do think it's worth your investment, it saves you time, is to do a case report training. Okay. So that it's really clear for you what goes in each of the sections. I think that would be the biggest takeaway. That it's not some simple thing, it's actually a skill. And it's a skill that you're developing.

[01:01:53] Bronwyn: Quite a complex skill as well.

[01:01:54] Annie: Yeah, and involves lots of skills to do it well.

[01:01:58] Bronwyn: Yeah, it does. Annie, if listeners want to learn more about you or get in touch, where can they find you?

[01:02:04] Annie: Yep, so they can go to the Provisional Psychologist Network. Um, That's where you'll find me. We also have a Facebook group, um, too, that PIT supervisors can jump into, particularly if they want to set up things like case report kind of groups where you do find a buddy. Um, their online forums are quite helpful for that. So they're probably the two places.

[01:02:24] Bronwyn: Excellent. And Annie, thank you so much for coming on the podcast. It's been such a pleasure to have your insights and your knowledge.

[01:02:30] Annie: Thanks so much for having me.

[01:02:33] Bronwyn: Wonderful!

[01:02:34] Listeners, thank you so much for listening. It's been good to have you. And I hope you gained a lot from this episode. If you liked this episode or any one of our other episodes, do leave us a five star rating and review. It really does help other people find the podcast. Hope you have a good one. Catch you next time and bye.