Ep14: Meet my Sister Dr Kate- how did we both end up here as a psychiatrist and psychologist

Hello and welcome to Unmasked Minds, the podcast hosted by me, Sarah the Psych on Instagram. I am also a psychologist in real life, and I deal predominantly with millennial women in this midlife chapter and all of the challenges and things that come up for us in this chapter. Now today I am absolutely thrilled to have a guest with me. This is my first episode that I have brought someone in.

I'm honored.

You should be. And if you can't tell already by the nature of our relationship, today I've brought my sister onto the podcast. My sister is Dr. Kate, and she's a psychiatrist in Sydney, New South Wales. Welcome.

Thank you.

And Kate is, you know, she's my older sister. And, you know, we've got the same dad. We have different mothers, but we've, we've shared a lot of our growing up together. And we've also shared a huge part of parenting together. Your kids are older than mine, but certainly been heavily involved in each other's lives throughout this chapter. And I invited her on here today because I really just— I wanted you guys to meet her. Because she's pretty cool, and she does have an Instagram account called The Mother Mind Doctor, and she's really releasing some cool stuff over there on women's health and burnout and a whole lot of stuff that I just think is really needed in today's world. And so I brought her on here just for you guys to get to know her a little bit. So this first episode is really going to be about getting to know her, and I also asked my Instagram audience to send through a few questions. So I've got some interesting questions to ask you today, Kate.

Great.

Um, and yeah, really just for you to get to know her, because we are also then going to film a bit of a mini series, because so much of the work that I do as a psychologist is closely linked with the work you do as a psychiatrist, and there are so many areas of crossover, similarities, differences, confusion.

Yeah, yeah, I think that's a really good place to start. The difference really isn't it between a psychologist and a psychiatrist, right?

And we've had so many conversations over the last few years around the differences and the confusion we've often felt in this space. So we've got a few episodes coming up, uh, there's going to be one on ADHD and one on burnout to start with. Um, but yeah, let's dive in a little bit on getting to know you. Um, most people listening have probably listened to episode 1 of my podcast where I through a lot about my upbringing and family life and how it led me into the corporate world. Um, a little bit about my schemas and sort of reaching my dark night of the soul where I then realized that what I was doing wasn't serving me and sort of my journey then to live a values-led life, which led me to becoming a psychologist and working in a space that I'm truly passionate about helping people, specifically women, and sort of getting to this point where, you know, it was a second career for me. I'd spent 15 years in the corporate world, but now I'm— I get to work in this space that I just love so much, and I get to help people. And I know your story is also fascinating. And, um, why don't you start with a little bit about how you became a psychiatrist? Because Again, it wasn't until later in life that you became a psychiatrist.

Yeah, that's right. So, um, thanks for the introduction. Um, I think, uh, from— we talked a little bit before about the idea of coming to these sorts of things later in life, and that was certainly something that I had the benefit of. And I say had the benefit of because while I had 3 kids under 10 when I went and studied medicine, yeah, and I had had, you know, previous careers, that it really gave you that kind of background of what it's like to be on the other side. Yeah, you know, to have that really, I guess, life experience of what it's like to know how to be a patient and then to turn around and do the other side of it really gave you much more understanding, I think.

Yeah, absolutely. And when she talks about that we've already had the conversation, we actually recorded this entire podcast episode that went for 45 minutes and we were muted at time. So as we navigate this, we're gonna have to like work out if we already said that or not. But we did. We had a beautiful conversation. And one thing that we both talk about is, you know, transitioning into— for you, psychiatry, and for me, a psychologist— later in life, and what that feels like and how beneficial that is for us and for our clients, bringing lived experience into these roles. You know, for me, when I was doing my massive transition when I was 30 years old out of corporate life and sort of what does this mean, what am I going to do now. I certainly looked up to my big sister who at a similar age, you know, after working in so many industries, which I'll get you to talk about, decided to become a doctor and decided to start this medical journey at, you know, in my opinion, I thought she was too old to, to change. You know, we're taught that you pick your career straight out of high school and then you study and then you put all your energy into that for the rest of life. And, you know, you sort of getting to a point where you were a mother of 3 children and saying, I'm going back to university for what, like 10 years? 10 years to grow a doctor, to become a doctor. I remember at the time thinking, she really is crazy. But also, you know, a few years later when I was in that sort of fork in the road of, you know, I'm— I felt old, but I was only 30, you know, early 30s, and thinking, ah, if I could design my life and choose whatever I want, I would do this. But oh gosh, can I really start this late in life? And you've been a huge inspiration to me on doing that, you know, on sort of saying, you know what, if I, if I want a life that looks and feels like this, then it's never too late to start. And, you know, if you hadn't started then, you wouldn't be here now. And it's such a beautiful story and important lesson.

Yeah, that's amazing. Yeah. And it was really surprising to hear that that was a big influence for you. So I'm glad that you told told me. Thank you for sharing.

You're welcome. Yeah, um, one thing you'll know about our family is we don't give praise very well or easily.

It's not in the DNA of our family, really, is it?

It is not, and we are continuing to unpack that both in our own therapy and together. No, but it's— yeah, no, it's something we don't do enough of. But, you know, for those listening, um, she, my sister, has played a huge role in me having the courage to step into doing the work that I do today. So thank you.

Thank you. It's interesting because I always talk about medicine as being my fourth child too.

Yeah.

So, you know, kind of went on and wanted to have the fourth and my husband said, no, I'm not having a fourth. I'm like, fine, I'll go and do medicine.

It'll be my fourth. Yeah. Wow. But I think, you know, back to that sort of lived experience, it felt really different for me because having children created this huge shift for me. Also, you know, going through my corporate life and, you know, whether it was burnout or whether it was, you know, just so much going on, a shift. Losing my mum, you know, at the same time I was going through a divorce and, you know, just trying to wear all the hats at once really forced me to look at what my values were and what living a values-led life would be and it would look like and feel like. And I think those types of decisions are difficult when you're young, because when you're young, you're still making decisions based off your family's values and your parents' values.

Yes. Yeah, absolutely. And I think we're in a really lucky point in, in history, really, where the environment is changing so that we can make those leaps. You know, we can say, I'm choosing this career when I leave school, but that's not to say I'm going to have to stay there for the rest of my life, you know. And it's become the norm that you have 3 careers.

Yeah.

And it really is like that, isn't it? I mean, you've had 3, I've had 3.

So, yeah. And I think there's still so much fear around that. Right around changing your career or changing your mind. You know, there's a bit of shame around it as well. I certainly felt that. And it was, you know, validated by people that, you know, I did value their word, you know, value their input. And it took a lot for me to sort of push back on that when people were saying, hey, no, that's not good. You've worked so hard to get where you are. Don't throw it all away. For me to say, actually, I see what you're saying and I can see how your values and your life prioritizes or would make that decision, but my values and my life, I'm going to make this decision.

Well done. Yeah.

And you probably felt sort of similar, like there's pressures from everywhere.

Yeah, I feel like mine was a little bit different in that I, I wasn't— I didn't go into the corporate world. Like, I, I did the business degree.

Yeah.

But then I went and lived overseas, so I kind of removed myself from a lot of that pressure.

Yeah.

And, um, and when I came back and I was around 30, that's when I sort of said, well, you what is it that I love doing? And I loved film. And that's when I decided to go and do a master's and do production. And that was fantastic. That's where I ended up meeting the father of my children on Mars.

Yeah.

So that was a whole nother story.

Yeah.

And then after having the 3 kids, it was really—

it's— sorry, the story is the film set was on Mars, wasn't it?

Well, yeah, it was a film called Red Planet. So we get to say we met on Mars, right? So, and that was, that was amazing. I mean, that's what I love doing was film, you know, it was sort of something that created this whole other world that you could tell stories and that you could see visually. And I loved that. That was our real connection point.

Yeah.

But by the time we had 3 kids, it just kind of got too hard to manage the juggling of the child, you know, that you couldn't get childcare.

Yeah.

For 2 months or 3 hours, however long you're doing for a film. So it was like, well, okay, maybe I need to look at retraining and how do I do that? And if it's going to be something that I have to do, it needs to be something I, I'm passionate about. Yeah. And I had thought about medicine back in school, but it had always just been so much of your life that was required to be taken up to do that study. And the, the new development of having postgraduate medicine was perfect for me.

Right. So it built— because you already had a degree, you could start a little bit further down the track.

Well, they just compressed it.

Yeah.

So you still had 6 years of study, but it was all compressed into 4.

Yeah. Wow.

But to me, 4 was like, okay, I can manage 4 because then I'll be back in the workforce.

Yeah.

What I didn't realize, of course, was that you were then studying and a parent and working.

Yeah.

So that was when it kind of led to burnout for me. It was really those kind of pressures. And it wasn't even just that structure. It was more about the kind of invalidating work environment, the poor pay structure in New South Wales Health. Don't even get me started on that, say, Fox. Yeah. And so it was a lot of advocacy work that I was doing as a representative for my trainees as well, my fellow trainees. So, so there was a lot of, I guess, things that came together that really ended up, for me, being something that was passionate around the idea of mental health.

And what do you— what value do you think you bring to this role as a psychiatrist now because you started later in life? Like, what is the difference do you think, than people who start earlier?

Well, I think we really touched on that idea of lived experience. I think that's huge. Yeah. I also think that you come at it from a different perspective rather than having that kind of analytical side all the time. And even though, you know, we're taught to look at things holistically, you look at the biopsychosocial side of things, having the ability to know what it's like being on the other side really changes things. Yeah. I mean, I remember something as basic as when we're doing our medical student exams and talking to one of the patients, and I was doing the physical exam and saying, oh, so I'm just going to have a look at a vein in your neck. And one of the doctors said to me, wow, I really liked the way you do that. And I was like, yeah, actually I didn't remember the name of it, but you know, it's great. So, but, but it's more accessible because if you're talking to somebody who's lying on the table and you're doing an examination, if you use complex jargon and terms, yeah, it goes over their head, you know.

So the way you were able to sort of simplify and make what you were doing relatable in a way with something that the lived experience and the, you know, being a bit older sort of added value to.

I feel like it did.

Yeah. Yeah. Cool. So one of the things that people ask me all the time is what is the difference between a psychologist and a psychiatrist?

What a great question. And can we just say that our New South Wales Premier doesn't know the difference either?

True. Right. And, you know, for anyone listening, like, it is confusing and that's something we're going to come across a lot. We talk, like just acknowledging that the work we do in the system that we work in is fucking confusing to a lot of people.

It's so difficult to navigate the health landscape. And I mean, we have federal, we have state, we have private, we have public. Who knows where to go, where for what, and where's the best way to do it is incredibly complicated. So I think that's where it's really good to have space like this that we can clarify some of this stuff.

Yeah. And just try to make it a little bit easier for people listening because because, you know, it can be a big decision for people. Do I go to a psychologist or go to a psychiatrist? So what would you— where would you start to explain the difference between a psychologist and a psychiatrist?

So I think the fundamental difference is that a psychiatrist is a doctor. You know, you have to go through medicine, you do all of your basic training, so medical surgery kind of training before you choose your specialty. And then your focus is on mental health in the medical profession. So, so a lot of the training is in the public system. We have obviously the psychological side of it as well. We tend to look at more the sort of long-term psychotherapy approach.

Yeah.

And that's part of our training as well. So that's built into it. Yeah. But we are fundamentally doctors and that's why we can do the medication prescribing.

Yeah. So, so a psychiatrist has a medical degree and then specializes in sort of the brain, right? Whereas psychologists we have a science degree, which I also— people find it interesting that psychology is a science degree. Everything is evidence-based.

Yeah, social science. Absolutely.

So we have a science degree and specialize in the science of psychology.

Yes.

Right. And so, yeah, you know, when people ask, should I see a psychologist or a psychiatrist, one of the major differences is that you can prescribe medication.

Yeah.

You know, so if someone comes to me and they're really looking— maybe they've been on medication for a long time and looking for something that might be a bit more effective for them, or they're looking for a diagnosis in the hope to access medication, then often in those situations, if that is their goal, then I might sort of say, hey, why don't you just see a psychiatrist to begin with?

Yeah.

Um, but there are other differences, right?

Yeah, I guess what I would say in part of that, what you were talking about before about being on medication already, is the role of the GP.

Yeah.

So obviously we know the GP is the coordinator of care. They're kind of central to to everyone's health journey, or they— that's the idea.

Yeah.

Um, and that they would then refer to you, they would also refer to me. So as a psychologist and a psychiatrist, so I think that's really important to have that awareness. And it may well be that you're talking to your GP, you know, your GP might have started you on medication. It could be for anxiety, depression, it could be, you know, a range of things. Yeah. But, um, when things I guess when you start to have these mental health challenges, perhaps that's when you would look to see a psychologist, because we don't want to straight away throw medication at you. It could be that you're working some things out, that you need to figure out some level of understanding before you— it gets escalated.

Yeah.

And so the idea would then be more like, well, okay, I've tried this, I've tried that, I've tried the medication, I've tried some psychological strategies, and, and you might have some time-limited, evidence-based approaches where you're sort of looking at maybe cognitive behavioural therapy, acceptance and commitment therapy, you know, these kinds of things. A lot of the acronyms I think you talked about. DBT, all of these sorts of things as well. And then the complexity is there that you say, well, actually, maybe we need to start looking at if we need medication to help support you to do the work.

Yeah. And what comes up for me when you say that is like, you know, I might work with a client for a couple of months or so, and then we decide that even though they're doing the work, they may benefit from some medication to support them while they're doing the work.

Absolutely.

You know, a lot of times I'll have clients sort of start on medication and then come to me saying, I'd like to in the future not be on medication, but I need it to be able to access the work, to do the work, to train the brain, to rewire the brain. But I often will refer back to the GP, because a lot of the medications, you know, anxiety and depression medications, the work is with the GP. So at what point do we see a psychiatrist rather than work with just the GP?

Good question. Uh, so the GP will have, you know, one or two first, uh, line approaches where you start with medication. Yeah. And once you have two failed trials of medication, it becomes what we call treatment resistant. And when you start looking at that kind of level, that's when we would recommend you go to the psychiatrist. Yeah, because then you start looking at, well, is that the right diagnosis? Is there something else going on? Are there, you know, more than one thing that needs to be addressed? Um, and maybe— I mean, I've had people that have come to see me that have tried every single medication under the sun, even with a psychiatrist.

Yeah.

And in the end, we've said, well, you know what, actually, I think we need to do psychotherapy, and we just need to do this regularly and really get to the bottom of this. If all of these medications are failing there's got to be something else going on underneath.

And so then you're looking at like schemas or, you know, that kind of thing, like more—

well, I think in the psychotherapy space that we do, certainly our teachings, it's more around developing that therapeutic alliance. I know you are really big on that as well, about that relationship that you have, and that you're looking to establish that relationship long-term and really explore a lot of these things of maybe what's happened developmentally, what's happened in terms of their progression over time and over their experiences, what their environment's been like. And, and it can bring up a lot of different things, and how you address it just becomes kind of core to what we call a formulation, you know, which you have too.

Yeah.

Yeah.

And so would you see many clients like that? Because my understanding is, you know, there are not many psychiatrists compared to psychologists, and I guess it's a lot harder to get into psychiatrists these days. So is that even an option for people to sort of go, well, you know, I know I'm dealing with some fairly complex stuff, I've got family stuff, I've been on and off medication my whole life, I know there's some opportunity for some, you know, maybe CBT or psychotherapy type stuff, but can they actually get into psychiatrists who have regular fortnightly appointments for them?

They can. Yeah, it is something, and there are some psychiatrists who specialize in that. Yeah, so it's actually an area of training that is an advanced training certificate in our practice that you can do to then do that as your main approach to psychiatry.

Also, psychiatrists— the cost is a big barrier for some people to access, you know, regular appointments. I know people get Medicare rebates and stuff like that, and the safety net. Yeah, and the safety net. Yeah, do you want to talk to that? I love when you talk to that, just briefly. What is— what does that mean?

So when you access, um, Medicare rebatable services, so things like seeing a psychologist or seeing a psychiatrist, you get a gap usually that you have to pay, and that gap can be accumulated throughout the year to the point of the safety net. And once you reach that safety net, it then means that your costs are dramatically reduced moving forward. Yeah. And you can have a family safety net.

Yeah. Yeah. A set amount, or it changes with each, uh, person's situation?

I, I think there's a single rate and a family rate, is my understanding.

Yeah, yeah, yeah.

And I guess we were talking before about the numbers, and I think that's a really valid point. Yeah, you know, we said there's 26,000 psychologists, there are 3,000 psychiatrists. Yeah, so, so I think you're probably looking at the really complex cases when you, you're looking at that kind of level where you have got that, you know, exactly, complexity and that treatment resistance, if you like.

And we also, we have aligned many times on the effort for some people of having access to both, you know. And we are in a very unique situation where we do refer clients to each other, and with our clients' consent, we can communicate and work, you know, on supporting them. And for some people, that's absolutely wonderful to have a psychiatrist and a psychologist on your team. You know, they might only see you once every 6 months or once a year, but it's nice to be able to have that little check-in as well, isn't it?

It's amazing. Look, and in the public system, we have an MDT, like multidisciplinary team. Yeah. And you usually have that in the inpatient environment in the public.

Yeah.

State-based. And, and often in private you don't have the luxury of that. So when you've got the opportunity to have that team, you know, that's really incredible for the people that come and see us.

Yeah. And when you, when you talk about that multidisciplinary team in the hospital environment, we're only really talking about real crisis kind of people that are entering that system, people in extreme crisis that have nowhere and they're then getting some access. And, you know, and there's lots of reports on the effectiveness and, you know, availability of that access, which we won't go into today.

Yeah, I'll get on a soapbox about that one too.

Um, but, you know, for most people listening here and for the most sort of people that are part of my community, they're not at that crisis point, but they, they're seeing things in their behaviors and their feelings and their emotions that they're not comfortable with, and they want to do the work because they don't want to end end up in that space. And it's kind of sad, isn't it, in our system that you don't get that support until you get to that point?

Yeah, I mean, that's part of the soapbox I have to say too. Yeah, yeah, the interface of those different sectors, you know, the private, the public, the state, the federal— it's, it's messy.

Yeah, yeah, it's messy and it's confusing. And we as professionals in this area, you know, it's one of the hardest parts of our job is navigating the system and seeing people fall through the cracks, people who are really trying to get support and, you know, can't afford it or can't access it for whatever reasons.

Yeah, absolutely.

But, you know, what can people expect in your words from the episodes that we're going to film together?

Hmm, good question. Look, I, I think I talked about this a little bit before, the idea of having the intersection of this space, you know, to really nut out what each of us do and looking at specific topics that we can address for people that are curious about what's going on and maybe whether it it actually addresses their issues.

Yeah, I love that. And you know, for me, I, I am very good at what I do and I specialize in certain areas, but almost every time we have a conversation or I come to you asking for advice or help, I learn something new.

It's great, isn't it? We both do.

Yeah. So I think it's just a really cool thing to bring to this community, to sort of add to that and sort of bring in your experience and your voice and your knowledge and to enjoy that because like you're pretty cool and you You know some cool shit, so let's share that with everybody.

Let's do it.

Amazing. Well, thank you for coming on today, and I'm really looking forward to the next few episodes. And for all the listeners out there, thank you so much for being here. Um, please jump on to the Unmasked Minds, the podcast Instagram page, where you'll have like the little reels that we release about our episodes, and give us some feedback. Let us know if you've enjoyed this episode with Dr. Kate. Let us know on that Instagram page what you want to hear from us, if you want to have her back, because we are so happy to get together and make some more episodes if you guys find it informative and enjoyable.

And yeah, interesting.

Let's do it.

Fantastic.

Thank you.

Look forward to it.