30 August 2017

Therapists and holidays

I write this a week after returning from two weeks annual leave. I have been wondering whether it might be an idea to give newer clients a hand-out to read prior to planned breaks so that they have a idea of how a therapist having a break might impact on a client. Most clients do not appear to be adversely affected by my having time off and I always do my absolute best to give as much notice as possible. Some clients value having a bit of a breather. However, during any holiday I take, some clients might be impacted negatively and although it might seem clear that clients with attachment issues and complex trauma would have more chance of being impacted, it is not always obvious to me who might be affected and in what way. It might not even be clear to a client that they are being impacted by their therapist's absence so open and honest dialogue is important and, on the part of the therapist, an awareness of this being a possibility.

Occasionally, a client might be so impacted that they withdraw from therapy completely without giving themselves the chance to learn and grow from the experience. I would venture to say that of the few clients that have disengaged from therapy without prior discussion this is more likely to happen following my absence. Of course this might be that time out from therapy has given the client enough space to decide that it doesn't seen to working for them but I strongly suspect that this is not always the case.

The importance of self-care for therapists

I very much value and enjoy the work I do but it can sometimes be emotionally depleting, especially if one is a busy, full time therapist and/or if dealing with serious trauma work. Taking time out from being a therapist is paramount for many reasons:

Avoiding burn-out - a therapist with burn-out who then has to take time off with stress might result in unplanned breaks which for clients are almost always much harder to deal with than planned breaks.

To regain a healthy perspective - this is particularly true when dealing with issues such as childhood sexual abuse and complex trauma. These are areas where even the most positive thinking therapist might start to view the world with a somewhat negative outlook, finding ourselves immersed in the darker side of what human beings are capable of. This can be one of the warning signs of burn-out and a reason why self-aware therapists will cap the amount of trauma work they take on as well as taking adequate breaks.

To spend quality time with friends/partners/children/family - important for almost all people, no matter what their job or lifestyle.

To have some alone time - also important for most people, perhaps particularly for the more introverted therapist *holds hand up*.

Modelling self-care - how can we expect clients to learn to value themselves and honour their personal requirements for self-care if we don't do the same by not taking adequate breaks?

Taking time out for other work related tasks - as a self-emplyed therapist I run my own business, update my own website and social media accounts, do my accounts and like all therapists, regularly engage in Continuing Professional Development such as workshops, reading, research and occasionally writing articles such as this. Due to my working full-time and having family commitments, I do not have much spare time to catch up on the admin side of the role.

I asked for therapists and people who are/have been in therapy to share any comments they had about the topic.

Comments from other therapists via my Twitter post

A therapy client's point of view (sent via my Facebook page)

I was kindly sent the following by somebody in therapy in response to my question about the impact of holidays:

I've seen many therapists and a flash point for me is always when they have long breaks e.g. the summer holidays etc. Although I am completely aware that all good therapists need to have breaks and look after themselves I find it so hard to reconnect with them after a break and this is often the time I chose to bail on them and not return to sessions. I find it very hard to bond with people, especially professionals, and find that a long break just makes me shut down and then I don't want to go back. Want is probably not the best choice of word.

The first time my current therapist, who is by far the best I've seen, was going to have a month off for summer she said 'While I'm on holiday can I ask you...' and I finished her sentence 'Can you ask me not to contact you as you need family time, you are a professional with boundaries etc' and I had that sinking feeling that it was all about to go wrong for me. But to my surprise she said 'Nope, can I ask you that if shit and fan collide please get in touch and we can have some communication?'.  Because she had said that I didn't freak out, feel trapped,  or indeed contact her, I think because I knew I could and I didn't feel rejected.

During the Christmas break I miscarried my IVF baby and I emailed her and we did meet up, her suggestion not mine, and that was so helpful. I know if we hadn't been able to I wouldn't have been ok about continuing sessions after Christmas.

I do completely understand therapists need holidays and breaks and probably need more than most! Clients, me included, can be very selfish and see long breaks as rejection or as a wobble in therapy and previous to my current therapist I couldn't then reconnect with them as they had laid down tight professional boundaries which were inflexible and made me feel 'controlled'.

Therapy is so intense , I see mine twice a week, and a break of a month is eight sessions and that seems insurmountable when you're in a mess!

Somebody else commented:

I really appreciate and value that my counsellor takes around a month off in the summer. Showing her commitment to self care and always well prepared for.

So as therapists it is important that we:

  • Take adequate breaks from the work
  • Give as much notice as possible to clients about breaks
  • Be aware of the potential impact of our breaks and introduce a discussion with our clients around the topic before and after

And for clients:

  •  Be aware that it is normal to be impacted by breaks so don't judge yourself negatively
  •  Bring any uncomfortable feelings about breaks to your therapist. If you don't feel able to talk about this with your therapist then maybe this isn't the right therapist for you
  • A good therapist will welcome discussion around any impact on you. It can be a valuable part of your process, particularly if you have struggles around trust, attachment or abandonment.

Please leave your thoughts in a comment below. I value feedback and we can all learn from each other.

12 March 2017

Recently published article on trauma work on counselling and psychotherapy

I used to blog so much more regularly however since working full-time as a private therapist (I went to 5 days a week in January 2015) I have had very little time for writing. Along with a busy life outside of work and campaigning for regulation of counselling and psychotherapy I often have topics I would like to write about...if I had the time...but, well...

Last year saw the important publishing of the Unsafe Spaces report which I co-authored along with Phil Dore* my fellow campaigner. Finding the time to focus on this was difficult but it is very important to me to contribute to discussion within the profession.

Then a few months ago I was invited by the online magazine The Counsellors Cafe to write an article. Having spent several months prior to that thinking about writing something about the difficulties of working with trauma I decided to use this opportunity to focus on producing something to get some of my concerns out there. So I finally got my act together and started to work on a piece which was published on 10th March entitled Care When Working With Trauma (click to take you directly to the article).

I had a few factors that had motivated me to write such a piece:

  1. Working directly with clients who have been abruptly dropped by a therapist and hearing accounts from service users in general about feeling abandoned when therapy is suddenly terminated with no warning or ending.
  2. My own journey of learning more about trauma from reading books by Babette Rothschild and Bessel Van Der Kolk and attending specialist trauma workshops such as those run by Positive Outcomes for Dissociative Disorders (now known as Carolyn Spring). I realised that there were gaps in my core training. 
  3. The realisation that a few years ago, when my therapist had to end sessions with me it was emotionally difficult, even though there were very good, ethical reasons for doing so.
  4. Hearing and reading various comments on counsellors forums which quite frankly have greatly concerned me about the competence of some practising therapists. 

Like anything I write, I reflected and immediately wished I had included more. I see this piece as work in progress and I have further work to do. I do believe that there is insufficient training in a lot of basic counsellor training and that there is a danger that therapists can unwittingly retraumatise their clients.

I've had some great feedback from other therapists who share similar concerns. I have done some research on whether qualified therapists believe their core training equipped them sufficiently for working with trauma. The findings were as I suspected; many did not feel that their training was enough. I just need to find an idle moment to make contact with some of the professional bodies who accredit training courses and see what their opinions are. Then bring it all together in a compelling article. It will likely take me while!

I don't want to put people off accessing therapy but I do believe that forewarned is forearmed and that as professionals we should be striving to improve our profession and keep it as safe as possible for our service users.

The work I value most is my working directly with my clients but the bigger picture of the profession is also very important to me.

(links updated Jan 2024)

*two days ago I received an official comment from the Professional Standards Authority on our report, requested on our behalf by Ben Bradshaw MP (my local MP and a member of the Health Select Committee). We are still awaiting as response from Jeremy Hunt.

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