Episode 5. Den Abreu on complex identities in the workforce and safety in the profession
Anita:
In today’s episode, you’ll be hearing my conversation with Den Abreu, the CEO and Principal Psychologist of Haven Psychology. I hope you enjoy our conversation as much as I did.
Before we get to Den though, I want to introduce myself more fully. In conversations about diversity it’s so important to position ourselves, to be transparent about who we are as it affects how we see the world. I haven’t fully done this in this podcast in my hurry to focus on our amazing guests. So I’ll let you know a few things about me. My name is Anita Gupta, I’m a clinical psychologist and have been registered for 19 years. My parents are North Indian Hindus who migrated from India to Australia via Canada many years before I was born. I grew up in a number of places but mostly in Townsville, the lands of the Bindal and Wulgurukaba people. As an adult I have lived and worked in Brisbane, Darwin and Melbourne, Naarm, which is now home. I’m a cis, hetero, middle class, typically abled woman of colour and a mother. I work in private practice in Melbourne, and have previously worked with people from refugee backgrounds, Indigenous people, children and young people in the care system, neurodivergent and gender diverse children, and really a whole range of adults, teenagers and children suffering from mental ill health. I feel lucky to do this work, I love learning and being challenged, and as you can probably tell, I love conversations with other practitioners that help us to be better at working with people different to ourselves. It’s important to note that the context of my conversation with Den, which came a few months after the Queensland government made the disappointing decision to suspend access to gender affirming care for teenagers, while announcing a review of gender affirming care. This has had massive ramifications for trans people in Queensland and around the country. We touch on this decision in today’s episode, and there is more to come in future episodes.
So today I have the pleasure of speaking with Den Abreu. Den is the CEO and Principal psychologist of Haven Psychology, which has offices in Brisbane and Melbourne. And can you tell us a little bit about Haven Psychology?
Den:
Sure. So, Haven started in 2019, initially in Meanjin which is Brisbane. And it's meant to be a space where our most complex and vulnerable clients can actually come and receive some support. We do see a lot of marginalized people, and we work in that more complex end of mental health. So those with complex trauma dissociative disorders, and just complex lives in general. And as we progressed and as people began to hear about us, we found that we were working more and more with the various intersectionalities, um, that make up humankind. So, people who belong to the LGBTIQIASB+ communities, those who are neurodivergent, and particularly I think because there is also the background that many of us have, with postgraduate qualifications in psychosexual therapy as well. So having a really good understanding of a few domains and a few important areas of people's lives and being able to tweak them, with the various aspects of humanity.
Anita:
I imagine a lot of people must be so thrilled to find your clinic.
Den:
I hope so. We are an employer employee model. So that, that's also nice, I think for our staff, to have that ability to not have to worry about, you know, the things that come alongside of a contract model, but being able to really be nurtured as psychologists in early careers as well. And that actually translates to, to clients. So, we work on a servant leadership style here at Haven, which actually means for me the priority is looking after our team members and their responsibility is actually looking after the clients, which works really, really beautifully.
Anita:
I'd like to come back to talking some more about Haven and the experiences of people there, but I'm wondering first a bit about what your experience has been like just to go back in time.
About your experiences of studying psychology. If you had any thoughts about what drew you to studying psychology and what it's like, what it was like for you being the person who you are studying psychology?
Den:
Yeah. Gosh, going back in time. Yeah, it's a big question, but also going back in time as an ADHDer where time blindness is a real thing. I loved studying psychology. And I was a mature age student doing psychology in the undergrad days. And that was at Curtin in WA and I did a major in psychology with a minor in sexology. And for me, going into psychology was not really about wanting to help people as such, but more to understand people, why they do the things they do.
I think all mental health, clinicians across the different disciplines of mental health we're all in mental health for a reason. And I do come from a very complex intergenerational trauma space. I do have my own experiences of complex trauma and dissociation as well. And so that's probably what led me more than anything else to go into this space. Why do people knowingly hurt other people? Why do people not mean to intend on hurting others? How do we repair that, why do we repair that? And navigating it as a mature age student. So I was in my thirties and it was far more meaningful for me than I think if I'd studied it straight from school. I had very young children at the time. My partner, my husband, was doing FIFO work. And I think coming to a space of who am I, now that I'm parenting and not wanting that intergenerational trauma to continue. And that's what led me to, to going into psychology.
Anita:
Such a powerful motivation, isn't it, when you have kids and you want something better for them?
Den:
Yeah.
Anita:
And so it sounds like, you know, you, you had your hands full when you were studying psychology, and the subject matter was pretty interesting for you, so it sounds like the experience of studying was pretty positive for you.
What about when you became a psychologist? And I, I know that we've exchanged a few emails and kind of chatted a bit before this, and you've mentioned something about. You know, just the experience of being a professional psychologist in a, a white centric world, and how maybe your identity was interpreted. Do you wanna talk about that at all?
Den:
Yeah, and I can actually circle it back to, to studying psychology. So I completed my master's at UQ. So we moved from Perth, where I did my undergrad, and then we moved to Queensland where. I started my masters. But in both programs, not a single lecturer was someone who was obviously not Caucasian. We were very fortunate in having been taught, some guest lectures by Dr. Tracy Westerman, who is an Aboriginal lecturer and psychologist and is doing amazing things with, with the work that they're currently doing, building an army of the next generation of Aboriginal psychologists. But that's one experience out of, you know, four years of undergrad and then an additional two years in the master's program. One of my tutors was actually a Torres Strait Islander . But those instances are so rare, you know? And had I been on a different timeline or if I had been doing a different master's, so if I had done, you know, org psych or something instead, I wouldn’t have had access to, to that tutor, to Daryl . But even amongst students, it's a very white centric, very privileged position to be in, to, to actually study psychology. And that actually does show up in the types of students who are studying. We've got students who have predominantly gone to private schools or to the higher tiered public school systems. And we are taught in a very white centric model. We are taught old school, you know, Freudian, white old man theories and principles, and it continues. And so, looking at the lecturers, they may not all be Australian. They may have some, you know, cultural diversity, but certainly not people of color, cultural diversity. There may be white South Africans, say for instance, or you know, American and Canadians. And it does play a role because we are encouraged to bring in cultural humility. We're encouraged to consider, you know, cultural diversity when we are doing our assignments, et cetera, and yet no one teaches you on how to do that because they've not experienced what it's like to, you know, hear the click of a car door being locked as, as you are going past someone, you know, walking across the street so that they're avoiding you. When you don't have those experiences of the small microaggressions and you're teaching about the larger, very obvious bullying, harassment, discrimination bigotry, you don't actually allow for the death of a thousand paper cuts, so to speak. And there are positive stereotypes, I'll use my, my heritage. So I have a Portuguese grandfather who married a Burmese grandmother, an Italian grandfather who married an English grandmother. And, so there is quite a diverse ethnic background for me. The difficulty, I think, with navigating a space, especially right now where in psychology we've got these new professional competencies that says, working with diverse groups, working with Aboriginal and Torres Strait Islander peoples using trauma informed frameworks, being culturally sensitive, and you've got a year to meet those requirements. And it's like, well, how? When we were never taught the theory to begin with from undergrad, so you almost have to go back to basics and and it can be very difficult and very challenging for some people.
Anita:
Yeah, it's a, it's a big change, I think, for sure. Do you have any thoughts on how that's affected who you are as a psychologist being within that kind of environment?
Den:
Yes. So. Sometimes in the past I have been accused of playing the race card, and it's a really interesting one. This is something I've spoken to other colleagues about, who are also people of color and in mental health as psychologists or counselors or psychotherapists. Having to be quiet, having to be discreet, not raising your voice so you avoid, you know, stereotypes and things like that. So when there is something that is big enough to actually go, no, we've got an issue here. In my experience is you need to frame it, that I need to frame it in a way that is palatable for the other person to, to experience and hold and understand. And so therefore, I almost have to downplay it. When it's just such an important topic that it needs to be shouted about, you know, you don't have to shout at the person, but the topic of bigotry, the topic of, you know, humiliating another person. These are harmful things and if we are meant to be modeling to our clients and if we are meant to be understanding clients more than just a diagnosis or, you know, an experience or a set of experiences that they have had. If we are to understand how they have gotten to be, we need to understand the barriers and challenges from a deeper level, then, oh, that sucks to be you. You know? Or, oh, that must have been hard. So if I, if I say to a colleague when you said X, Y, and Z, my, my reaction was this, and I wonder if this is the kind of conversation we're having with clients because I can hold so much more as a health professional and understand where you're coming from. But when our clients, or when the people in front of us don't have that ability and, and shouldn't have that ability when they're in the rooms with us, what is that like for them? So then, you know, oh no, you're just being sensitive. Den, are you playing the race card here? And it's like, no, because I've sat on this for three days. As I've tried to dumb this down as I've tried to whitewash this for you in a palatable way, it is no longer the race card. This is a concern that I have that is, you know, that requires either a repair in in our relationship, or I'm highlighting this to you so that it doesn't actually come in anymore in therapy sessions or something like that.
Anita:
I think this is so profound what you're talking about. And I just wanna bring out maybe a few different threads. Because I think there's so many parts of, of what you're saying. I guess one is maybe a sense of alienation that can come up when you are in a profession, when you're a person of color or part of another marginalised group, and you're trying to talk about the impact of those aspects of identity because you've experienced them yourself and you understand that that's what happens, and you understand how profound it is. That sometimes that can mean that you are alienated, because other people might not wanna hear it or they might not like the way that you say it because there's some kind of, sometimes an expectation that it will be expressed in a way that maybe it isn't emotional, which I'm not sure quite how you do when you're speaking from your own experience. And the mental effort of trying to figure out a way of communicating what it's like to be part of that group, to someone in the majority group in a way that can be heard, and then potentially having the experience of being dismissed even after doing all of that, thinking like that. All of it, it takes a toll.
Den:
It does. And I think when you are doing it from, it's almost like you have to have a Part A statement. So you give the context, this is about me wanting to support you and your clients. Say for instance, so as a board approved supervisor, I will always introduce, especially now with the new competencies that we have to meet, what does this look like for diverse groups?
So, in terms of, of, diversity, not only am I a person of color. In every protected characteristics, I can tick a box except for being Aboriginal or Torres Strait Islander. I am queer. I have ADHD, so I'm neurodivergent. And so when we, when we are, when I'm talking around cultural diversity, I've always used the term, cultural diversity beyond ethnicity. Because I think most people will think about, you know, race as the first port of call, race and ethnicity when we are talking about culture, but then they might include things like, you know, religion or socioeconomics is different types of culture, but not necessarily some of the other forms of culture.
So we do add context. So I add context. Here is what I am framing and then here is the issue. But when, when, when we think about. How do we frame it in a way that it's palatable for somebody to hear it? It is almost that Part A, Park B conversation to have had. And then the Part C, which is, you know, a week later or whenever it might be, moments of non-conflict. Hey, how are you and I now going with that conversation? How are you and I now going after, you know, moving forward?
Anita:
I think there's some really good ideas then about, I haven't really thought about it that way, about how, to be able to have the conversation, uh, safely, you know, constructively. To be able to have, bring in a few different parts of that and think about it as this ongoing checking in about how the conversation is going.
Den:
I was just going to say even through all of that, the onus is still on the person who's marginalised, the emotional labor, the cognitive labor. The sleepless night. So the physical labor from that, you know, the, as you're washing your hair and going, oh, should I say it this way or should I say it that way?
There's a lot of thinking that goes into a conversation that people who you know, and it wouldn't matter if it was like, you know, do I need to disclose a disability at work or do I need to disclose, queerness. How do I ask for an a accommodations at work? The onus is always on the marginalised people, and that's actually not okay.
Anita:
Yeah, and I guess that's that intersectionality perspective, that it's power and privilege, and that belonging to these groups is, a dimension of unprivileged. And then, and you've sort of got to find a way to ask the majority, to, to hear your experience. And they don't have to because they're in the more powerful group. It's a confronting way to think about it.
Den:
Yeah, it is.
Anita:
When we first spoke, I was really struck by. Often, um, if I reach out to another psychologist as a person of color, I guess people can feel safe quickly . But, you know, and I, I was struck by how when we made contact, actually it was really hard. It certainly wasn't something I could take for granted that you could feel safe talking to me. I hope it's okay to say and because I think it was really important for me to experience that actually for you, as a, as a queer person who's also a person of color, various other intersectionalities, who's working - and I think also this is about you working with a group of people who have identities that are so complex. You sort of really needed to know whether I was on your side or not. Because it's not assured that somebody who's in the profession, who's a psychologist, even if they're a person of color, that they get it.
And so, yeah. It makes me think about how exhausting all of that is, and then added to that, there's so few refuges, I guess, for you, in terms of places where you can feel assured of being safe.
Den:
Mm-hmm. So I hope I didn't make you feel uncomfortable.
Anita:
Not at all. Not at all.
Den:
And, and I think, you know, especially with being gender queer, gender fluid, gender is such a spicy topic right now. And that's here in Queensland. It is, you know, all over Australia with gender affirming care internationally with all of the trans bans, et cetera. Even though the professional competencies speaks to gender identity, gender expression, and gender diversity. There are a lot of psychologists out there who actually don't believe in gender affirming care or don't understand gender affirming care. And, there are a group of people who believe that if you are also, neurodivergent or disabled in some way, that any gender affirming care, and by that, they mean hormone treatment specifically, so puberty blockers, if you are a prepubescent, and hormone treatment if you're not - gender affirming care should only be allocated or considered around the ages of 25 to 30. And that blows my mind because a, not everybody wants hormone treatment. Not everyone can afford hormone treatment. Not everyone experiences gender dysphoria. So there's a lot of assumptions that are being made about gender diverse people, transgender diverse, and non-binary people. And the misinformation that goes on.
And so when I am talking to people, regardless of whether they're a health professional or not. I can't take off my facial features. You are gonna see that I have ethnicity here, that’s not Australian. I used to be in a much larger body, so there was also, you know, a lot of shame and stigma around being in, in larger bodies. And so with a trauma history to boot, being invisible is safe, right? Being in a bigger body, people don't want to look at you. Right. It's easier to be safe there. But also the amount of layers that, okay, you appear to be safe with my ethnic heritage. I can talk to that. Oh, you are making comments about queer people. Uh, okay. So I can't disclose that then. Oh no, not everyone is a little bit autistic. You don't understand neurodivergence then. Okay. So I can't disclose that. Because you're gonna make a lot of incorrect assumptions about who I am because of all the intersectionalities that I do have and you know. When I do speaking gigs, presenting at conferences, it's there. I'm a person of color, I'm an ADHDer, I'm gender queer, da da da. Do that with what you will, because I think if we're not seen, then that next generation of health professionals, the next generation of young people with histories and intersectionalities like mine won't have somebody to be able to go, oh look, there are people like me out there. And I think that's so important, but it's in the disclosure, it's the inviting in versus the coming out of things. Yeah. Just like our clients, we have to earn the right, you know, to hear our client's stories. I'm not sharing everything willy nilly with anyone, you know, have had some bad experiences, so.
Anita:
Yeah, there's that negotiation of visible and invisible parts of your identity there. I wonder if you could talk a bit about the fact that, my understanding is that your clinic, you have a lot of people who are gender queer or people of color or, you know, multiple, you know, neurodivergent or multiple kind of identities. So you’re supporting a team that has these marginalised identities in a world that can be unfriendly to that, to people with those identities, and also then supporting that next layer layer, supporting clients with those identities. I was just thinking a bit about what that's like, especially say in recent times where there has been, there has been these statements made around gender affirming care, particularly in Queensland. What that's like for your clinic because of all those layers.
Den:
Yeah….
Anita:
Is it too big?
Den:
It's a huge one. Look, I work with the most amazing humans. I am so lucky that, you know, people like to come and, and join us at Haven. Like my last few team members, we didn't have ads out. These people were hired because they wanted to work for us and sent a, you know, just a cold call or other psychologists business owners have gone, hey, I've got a clinician for you that would be perfect. And so that's where some of our more recent team members have come from. And because we do work in a very sex positive, gender affirming way, like all of our socials, what you see is what you get really. And me being an ADHDer and Michael who is our director of business operations, is also neurodivergent and neither of us have the time nor the inclination to be micromanaging people. I can't manage my own time, let alone a whole team's worth. So, you know, there's a lot of flexibility in that. And we have different days, different shifts. We work in a very neurodivergent affirming model, which means that, you know, different office spaces, different needs. So where we currently are, we moved into this place, in March of last year. So we're in here one year now and to be able to have individual lights in everyone's room, lamps, being able to pull down, you know, blinds and things like that, that makes it for a much more sensory and individual sensory space to navigate for our team who, you know, are neuro divergent.
When we are talking about queerness, you know, that adds a layer. And the research is very, very clear that, you know, neurodivergence and being a member of the queer community do overlap significantly. And I think that is because when you're a neurodivergent and you're able to think outside of the binary, and the world loves binary, we're good, we're bad, we're fat, we're skinny, we're sad, we're happy, you know. It's in the nuances of content, meh, healthy, you know, and working in the gray is actually very difficult in general for a lot of people, especially health professionals, 'cause we wanna be right. And when we look at the history of being marginalised, you are never right. You have never belonged. You have never been seen fit to be included, let alone have a seat at the table. Have, have you even been invited into the dining room, let alone have a seat at the table. You know, so it's all of those things that Michael and I thought about when we, when we created this, this new space for our team, but then it went beyond that to what do, what do we need for our clients?
So, you know, not having strong smelling rooms. So essential oils aren't necessarily a thing. But we do have smells for those of our clients who dissociate or who are sensory seeking in terms of smells. So little coffee beans or, you know, other things that may go along trying to work for the majority of people, whether they're their team members or our clients. It is what is going to make, from the moment you walk into the door before you even set foot in your session, how do we down regulate our clients? And we have a beautiful tea menu. We have hot chocolates and coffee and all of those things, but you know, so the smell from herbal tea, because clients have had to get a bus or two or the train, they've had to navigate a lot of sensory stuff plus whatever they're coming for. And this would be the same for team members. You know, they've had to navigate driving, getting public transport. So by the time you get to your office, you need to downregulate again before you can see people. Because if you are not regulated, you can't help regulate somebody else. And that's just not about in that moment, it is the history and the understanding of, you know, DSM being marginalized, homosexuality was in DSM-III you know, gender dysphoria is in the, is is in the current DSM but in the ICD, it's actually under sexual health. So it's navigating who you are, where you are. We think about our First Nations people. Once upon a time, they weren't even considered human, they were put in flora and fauna, you know, so knowing the history of being othered is important when you are working to support other people, because if you don't have that understanding, and then you try and get the understanding with the people in front of you, whether they're your team members or whether they're your clients, and even worse if they're your clients, and then you are asking, what does that mean? Or explain, teach me and pay me your session fee while you are teaching me. You know, that's a little on the nose. So being able to adopt a leadership style that encompasses recognising anti-oppression, recognising anti-racism, and building that into a framework that is suitable for staff, that is suitable for clients, this is something we are committed to.
And I say we, this is Michael and I, so Michael is very white, you know, origins of ten pound poms on both sides of his family. So he's had to learn to navigate and see when people are having a go at me because he never used to see it. He never used to hear it. And now, you know, comments like, oh, the Muslims from across the road are stealing our mangoes, you know, or the Indians are saying this, and he's like, well, how do you know they're Indians? Did you look at their passports? How do you know they're Muslims? You know? And actively on Facebook, in family discussions in, you know, everyday conversations, calling people out. And it doesn't need to be in your face. It can be , oh, so how did the introduction of the passport come in? I'm a bit confused, you know? They can be humorous. They can be gentle. They don't have to be in your face.
Anita:
I love the reference to mangoes and it makes me miss the north.
Den:
I love mangoes and, and quite frankly, I think it, it would be more than one group of people who would be stealing them.
Anita:
Yeah, why wouldn't you? So, you know, I think this sense of the thoughtfulness that's needed to employ and sustain a diverse workforce is one thing you're talking about, and that's so important because when you have a diverse workforce, it means that people can come and find someone who gets them. You don't have to have someone with exactly the same identity, of course, but it makes such a difference to people to have a diversity of psychologists or a therapists to choose from. So that's, that's one piece, isn't it? It’s not just educating more people, but also being able to provide employment conditions that can help them to survive. And then there's another piece around helping people to work with different, like people who are different to themselves as well. Of course.
I wonder if you talk a little bit about, your sense of what sustains you in doing all of this?
Den:
Honestly, I think it is the ADHD, because I have a million ideas in my head all the time. And I will so say yes, being the Principal Psychologist, the CEO, Board Approved Supervisor. I have lots and lots of roles, ‘cause I'm still a clinician. I'm still a psychosexual therapist as well. There's so much to do and I love doing it all. Having all the different ideas. So whilst I can have lots of different ideas, I actually need people to implement them because I'm a big goals, big ideas type person, the day-to-day minutia of doing it, not my skillset. And so this is where the team really come alive. We have people whose strengths are in social media. We have people whose strengths are in the writing of, you know, blogs etcetera. We've got people who love creating programs. We've got people who all they wanna do is be the best damn clinician they can be. And no shade to anybody. Like we all need to know where we're at and where we wanna go and move to that.
And being able to have the flexibility is important. And I think that's where I get my…how do I keep going is because there's always something new and you know the ADHD of following the shiny butterfly, I can be my own worst enemy. From following that shiny butterfly. I can absolutely derail some important projects and I have done that. And, and so learning what neurodiversity and leadership can mean, the beauty of it, but also my own personal challenges that I need to sort of keep mindful of.
Anita:
So it's like hard to separate the ADHD from the….well, it's the creativity and the energy that you have in the work is, is not, you can't separate from the ADHD. And then maybe also, I'm hearing a sense of a creativity and energy in the workplace in general. And it sounds like that's kind of comes from diversity or, you know, embracing the fact that people are all bringing different things and that that's constantly opening you up to new ideas or, or new ways of doing things as well.
Den:
Yeah, absolutely. And I mean, yes, self care is really important. If I didn't have, family who are really mindful of when I don't see that I'm taking on too much, they’ll have a gentle word in my, my ear, you know? Because I, my babies are now young adults and, and finishing university and just finished university. So wanting a different world for them is important. Having that legacy is important. Surrounding myself by like-minded people, like yourself and some of the other business owners that I hold dear. It's really important to surround yourself with like-minded people, but also people who are going to challenge your thoughts and beliefs because, you know, one day maybe it is actually me holding the race card because I'm just so overwhelmed that all I'm seeing is challenges and you know, I'm just going, it’s because I'm Burmese or it's because I'm, you know, queer And it may not be, it might just be because of being an ass that day. So being able to be held accountable is also important as part of that self-care routine.
Anita:
Thanks so much for sharing your wisdom Den. Is there anything that you feel like we haven't covered that you think it's important for people to know?
Den:
I think for health professionals when you are not understanding someone's intersectionality and how it might play. It's really important to understand your client. So asking the question, what does that mean for you? I'm gonna go do the research about being, you know, gender diverse. I'm gonna go do the research about being, neurodivergent or whatever it might be. But what, what does this mean for you? That is absolutely appropriate. Go back and do the research yourself and then come back together with your client. You know, I've learned this, or I've gone and had supervision with a person of color. I think that is essential if you are working with people even if it's not the same cultural background as your particular clients, but understanding some of those challenges. And it's not only about lived experience, because I think to be able to go, oh, I have lived experience. I can work in this space - is not enough. You need to have theory behind it. You need to have grounding and techniques and approaches behind it, but to understand a lived experience. And having supervision around that, because if you, if you haven't experienced it, getting it secondhand from your client who is already emotionally, vulnerable, may not see some of the things that your supervisor would say, okay, implement this, or, you know, read this stuff.
Everyone's got a part to play. And I think with the professional competencies that are coming out for psychologists, but also just in general with what's happening in the world, we need to understand each other at that deep human level, and a lot of what is happening is actually societally endorsed. And so the challenges that come out for our clients, for ourselves, where the structures, the social structures. So if we've got one of the most powerful men in the world saying it's okay to hate. And even better than hating someone is acting on their hate, that has ripple effects, you know? And it's not a safe world for a lot of people right now. And a health professional, can be an anchor to some of these people and, and, and I think that's a really beautiful thing that we can offer.
Anita:
Absolutely. What a beautiful note on which to end. Thanks so much for your time and thanks for all the wonderful work that you do.
Den:
Thank you for the opportunity.