24 October 2018

On therapists and retiring


by Amanda Williamson Reg MBACP(Accred)

I recently heard that a prominent local therapist, Bronwyn Carson, is due to retire at the end of the year. My first response was to feel surprised and saddened, quickly followed by a “Good for her”. Selfishly I worried that this was one less therapist for me to refer clients to.

I wrote to Bronwyn to congratulate her and ask about whether she was taking on any short-term work in the meantime. I received a lovely message back which was truly heart-warming. It was clear that Bron loves her work and also loves life and is embracing what is to come.

This news about Bron coincided with me finishing reading IrvinYalom’s Becoming Myself. Without going into too much of a book review here it is very interesting reading about his childhood and development as a person and as a therapist. I find it intriguing that he is still practising at 85. He writes in the book:

“Since I have helped so many people deal with aging, I thought I was well prepared for the losses looming ahead, but I find it far more daunting than I imagined. The aching knees, the loss of balance, the early-morning back stiffness, the fatigue, the fading vision and hearing, all these catch my attention but are minor compared to the fading of memory.”

Yalom discusses issues around ageing and dementia. He writes about witnessing other therapists in his therapist group, having to be removed from the profession due to no longer being fit to practice with issues around cognitive decline. Uncomfortable but an important consideration.

Anne Power explores such issues around retirement, planned and unplanned, in this article published by the BACP. She draws from the research published in her book Forced Endings in Psychotherapy and Psychoanalysis: Attachment and loss in retirement. In the BACP article she states:

“There is no single blueprint for retirement, but one principle is very clear: the responsibility to retire at an appropriate time lies with the therapist. We can’t wait for a signal from an insightful colleague, or for referrals to dry up or clients to leave us.”

Death and decline is a taboo subject and we don’t talk about it openly. My colleague Roslyn Byfield campaigned for the inclusion of the requirement of Clinical Wills in the BACP Ethical Framework. Roslyn has long been interested in the impact on clients of sudden endings in therapy. She wrote in a letter submitted to the BACP publication Therapy Today:

“…practitioners, especially those in private practice, must face the fact of their own demise and plan for it as part of a responsible and ethical stance on work. What gets in the way are the sense of omnipotence, phantasies of immortality and loss of identity if no longer working…we cannot assume we will know when to stop. Anne Power’s research found a good number continuing into their 70s, 80s and beyond, exacerbating the risk of ‘dying in harness’ (some with no clinical will in place). This can lead to collusion between client and therapist regarding the latter’s decline, the former effectively adopting a carer role.”

When I have wondered about my own retirement (partially down to suddenly panicking about lack of pension provision and how I’ve left it rather late at 46…) I assume that I would probably work until around 70, health permitting. Maybe longer. I like what I do, a lot. It seems to be helpful. Being honest, it gives my life some sort of meaning. But what if I’m not very good as I age? What if my brain is not sharp enough to be a safe and effective therapist? But then I did see Yalom when he was age 80 and he was super sharp.  Bronwyn is retiring at 65, and has plans for how to spend her time, checking off her bucket list.

I first heard about Bronwyn’s presence on the Exeter therapy scene before I trained as a therapist, so well over 10 years ago. I heard through a friend, then another, then another, about this brilliant therapist. She’s down to earth, she’s challenging, she’s warm, she’s real, etc. As I was considering being a therapist at the time; I decided that if I did I’d very much like to earn a reputation like that.

During my training I was aware that a couple of peers saw Bron for their compulsory therapy as trainees. Some of us talked about our experiences of our therapists and compared notes. I was aware that she had tighter boundaries than some other therapists e.g. charging for missed sessions…expecting regular attendance. I wasn’t so sure about that 10 years ago when I was in training…things do change and I have learned that good boundaries provide a better holding for the work I do with my clients.

Our paths didn’t cross professionally until I requested to meet with her in 2015. I needed another female therapist to refer potential clients to. As it turns out, unsurprisingly, Bronwyn was/is also very busy but at least it was someone else I could trust who might have the odd space.

We met at her office and it was lovely to chat with her about ethics and integrity. She spoke about her work in a way that was respectful, warm and confidential such that I have felt very happy to refer clients to her. Hence feeling saddened and aware that her retirement is a genuine loss to the therapeutic community.

It prompted me to have a little exploration around therapists and retirement, hence this post. If I am fortunate enough to choose when to retire I would like to do it with grace and with a quiet celebration of my work; as an honouring of the intimacy and trust of all the therapeutic interactions; all those therapy hours listening to people’s truths.

Bron very kindly agreed to me interviewing her about her impending retirement so that others might reflect on their own:

Please tell me how you came to be a therapist.

I came to be a therapist, as I needed to get back into full time work after having my family. I believed if I had to work for the next 25 years, then it would be sensible to find something I really enjoyed. I had worked in the Samaritans voluntarily for about 6 years prior to this time and loved it. I felt so engaged in this work and it seemed to come naturally from within.
Retrospectively I realized this was my apprenticeship into the world of therapy.

How has your practice changed since starting out?

In the first 8 years I worked in a G.P. surgery and also held a job as a lead Counsellor in Occupational Health. Working in the NHS gave confidence and credibility to me as a professional. Alongside this I had a growing private practice. There was a definite point in time when I had to choose between NHS and private work, as my reputation grew, and the number of client hours increased alongside this.

I chose private practice for 3 reasons:

• I was now getting known in the field and had enough referrals from clients who had enjoyed good outcomes working with me.
• I liked the concept of working for myself, in a room that was of my choosing, professional, but not clinical and in the convenience of my own home. (I was fortunate to have the facility for this, yet a private room rented would have been an equally good option)
• I would earn double the hourly rate privately than that in the NHS and I was now for the first time starting to really think about the concept of pension planning and saving for my older years. I was now in my mid to late 40’s.

What aspects of the work have you most enjoyed?

The aspects I have enjoyed the most have definitely been working with people of all walks of life. I have loved the diversity of the job and the challenges we are presented within this style of work. No one day is the same, no one person is the same, no one problem is the same, everyone experiences life from their own unique perspectives.

When did you decide your retirement age?

I always thought I would work until I was into my mid to late 60’s. I have always known I would not work beyond that time as I have great pride in my work and it has been my intention to retire when I am still operating from my best level of competence. Every decade that I have lived in my adult life I have been aware of my changing self. I know I cannot do the same things at 65 that I could do at 35. I believe it is the same with our competence as
therapists. Our wisdom and knowledge grow throughout our career, but time is also running alongside that and our mental agility does slow down and change too. My observations of older therapists over the years, has gained me great insight into preparing for retirement both in service of self and my clients.  My experience of life in this field of practice is that sometimes people are not aware of declining competency and cognitive decline, hence my decision to retire now whilst I still am!

What advice would you give a trainee therapist and a therapist such as myself who are perhaps midway along the journey between starting out and retiring?

My advice to all therapists is we must all keep in sight the reason for doing the work that we do and also when to stop doing it. Our work is about being selfless in the service of others, offering a service that is safe, has integrity, and can be trusted. When I hear supervisees saying – I can’t afford to retire, or I have no other interests I will be bored if I retire - I ask - how is this in service of your clients? Our clients are not here to fill our short fall of financial planning for older age. Nor are they here to fill our lack of social interaction outside of the therapeutic room. So my advice to all therapists is to always work towards the wanted outcome of the client. Find out from the client what they want from therapy. Help them to achieve this outcome and lead them onto autonomy. Encourage them to move on, let go.

What learning has there been for you since declaring your intention to retire? Has this led to anything unexpected?

Since declaring my retirement I have had a number of interesting “learns”. Firstly I have been through an unexpected gamut of emotions! Am I doing the right thing? Will retirement suit me as I have been so engaged with my work for so long? When clients ring up will I see the odd one for old times’ sake? I realized in order for me to retire I needed to close the door behind me with no hidden codicils (modifications). So I set myself a clear date. December 19th 2018. I cancelled my insurance from that date on. (I know I would never practice without it) I have given due notice of intent to clients, supervisees and professional bodies. And then just like I have done in other areas of life I started to research, to find out what a good retirement should look like. I now have an ever-growing bucket list of things to do in this new phase of my life, starting with a celebration holiday in January to kick off the year. By doing this, I have become surprisingly excited about retirement. I have started to look forward to it. I have given it momentum by counting down the weeks of work left to do. All of this process was modeling the underpinning of my work with my clients, the process of taking responsibility for life choices, making them work for you and looking forwards not backwards. Celebrating successes to raise self -esteem. I made a decision to
make my retirement as successful as my working life and I know I can do this, as I am the architect, designing its success.

So where are you now weeks off your date of retirement?

Many people have been surprised at my decision to retire, as, in a way I have been. I began the process at the beginning of the year. A dear friend died unexpectedly causing me to review my life and retirement goals. All the background planning to support my retirement led me to be able to take up the option of retiring now. As the news of my retirement has drifted out into the universe, I have been greatly surprised by the wonderful response. Some
clients have asked to come in and say goodbye and to tell me of the progress they have made since our therapy ended. Some have asked to come in and do a short piece of work before I go. Some just wanted to say thank you. I have loved my work and I feel this greatly as I say goodbye to a profession that I have been proud to serve and enrich and which in return has enriched my life.

~

This looks like good modelling for how we as therapists should handle retirement. I value Bron’s commitment to clients and the fact that their needs should be at the heart of our service. I am sadly seeing an emerging sense of entitlement within a pocket of the profession and wonder about the integrity of practitioners who emphasise their own needs above our service users and the profession as a whole. We would do well to listen to and take heed of Bron’s words.

I went onto Twitter to ask about other people’s experience of their therapists retiring and received the following: 

“It came a bit as a shock to me. My therapist and I had said goodbye after 8+ years working together. Three years later I had a bit of a life event and I contacted her for some more support, more for time limited focussed work than long term exploration and resolving some old issues. When we met she said she was winding down and retiring in a few months. In that session I didn’t register much but afterwards I felt quite scared and lost. My secure and safe go-to was no longer going to be there. Like I was suddenly on a high wire without safety net. When we spoke about this later I realised that actually she was more or less retired already and only had taken me on to support my process of really saying goodbye to her and learning again that she wasn’t my only safety net and that actually the biggest safety net I had was my own. All in all it was a good experience because she was so attuned and gave me the time and UPR*”.

*unconditional positive regard

When I was researching for an article on working with trauma I learned how abandonment in therapy can be traumatising. That sense of abandonment can be perceived rather than intended but can still provoke a strong emotional response and a therapist retiring can be perceived, by our vulnerable part, as an abandonment. It might also trigger old pain around the loss of grandparents or parents.


Colleague Hazel Hill, a BACP Accredited therapist and supervisor shared the following about her Supervisor retiring:

“It was wrenching news to hear that my supervisor was retiring due to ill health. I felt sad. She supported me through my accreditation and through my early days of private practice. We had many laughs too. I loved her eccentric ways and our thinking (and cynicism) was perfectly matched. I was totally understanding to her retiring but if I’m really honest I was slightly cross at her for leaving me in the lurch.

She gave me plenty of notice and a list of supervisors to contact but I buried my head in the sand and told myself it was ages away and did not start looking for a new one early enough. In hindsight this was not helpful. I ended up having a year moving around different supervisors. I think I was trying to replace her and did not give any new supervisors a chance. I focused on my old supervisor’s personality rather than thinking what I wanted from a supervisor. In some ways, although I still miss her, it has been good for me to focus on what I actually want from a supervisor and to make the most of my sessions now.”

I was also contacted by a practising therapist who shared her thoughts around her personal therapist:

“When I decided to train as a psychotherapist, I asked my own, older therapist if she was considering retirement, as I knew I was making a long-term commitment to my own therapy. She said no, and we had worked together for about 8 years altogether before she suggested that perhaps we should stop because of my "chronic resistance" . I wanted to stay in therapy until qualification, and didn't want to start work with a new therapist at that point, so we negotiated a continuation.

When I gained my qualification, we worked through closure and ended with the agreement that she would come to my award ceremony some months later. In the meantime, she contacted me more than once, which I found invasive, to tell me that she was unwell and she repeatedly made mistakes about the details of the ceremony. At the ceremony she told me that she was now semi-retired, giving up membership of her professional organisation and working only on a part time voluntary basis. I later discovered that she was in fact almost 80 at this point. I wonder if she had in fact wanted 
or needed to retire at the time she suggested stopping work with me, but 
had not been able to acknowledge that.”

This vignette highlights the possibility of doubts around fitness to practice in old age and whether all therapists are self-aware enough to ensure that their ongoing practice in later years is truly with the best interest of the clients at heart.

As Bronwyn alludes to above, we practitioners need to take responsibility for our own old age, particularly if we are self-employed, to ensure that we do not leave clients or supervisees in the lurch nor practice beyond a level of competency in order to fill a short-fall in our planning. What are we modelling to clients if do not face up to our inevitable old age and decline?

I’ll leave you with some food for thought:

Anne Power’s words from the article linked to above:

“Talking to colleagues is usually a great way to work through our difficulties, but sadly retirement is often still a taboo subject. This may be because of the association of retirement with aging and dying, the fear of being seen as a ‘has been’, as well as the risk that referrals might dry up before we are ready to stop.”

And Roslyn Byfield:

“If we cannot face our own endings how are we entitled to work with others in their dark places?”

So, let’s talk…







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