Therapist heal thyself

What does self-care look like for counsellors?

This week I’ve been fighting a bug. (You don’t need to feel sorry for me, I’m doing a great job at that.) As I decided each day whether to go ahead with client appointments I’ve been reflecting on what was The Best Thing To Do – for me and for my clients. Never an easy one to figure out, this is even less clearcut with online work when the factor of “Is it in the best interest of my clients to be infected with my snotty bug?” is removed. And I don’t have the additional effort of hauling myself through the cold to a rented room in the city.

I’ve been remembering an article I read when I first started working with clients (alas, I can’t remember the reference) which spoke of the ethical requirements of self-care. That as therapists we have a professional obligation to look after ourselves so that we are in the best possible position to look after others. At the time I read it this was gold for me; if I had a duty to look after myself it meant that I would do it, as I could circumnavigate the internal messages that told me I was being self-indulgent by doing so. possible.

The downside of my interpretation of this requirement is that my tendency to ‘do things right’ then kicks in, in the area of self-care, too; I find myself asking myself if I’m short-changing clients by working when I’m not 100% in peak physical and mental condition (i.e. coming down with a cold). That battles against the belief that my clients need me, that I’m letting them down by cancelling. (As counsellors we sometimes forget that our clients continue to live and function pretty well the other 167 hours of the week that we’re not with them.)

I’m sure my perspective is skewed by being inside the therapy world, but sometimes it feels to me that counsellors are particularly demanding of themselves and each other in the need to do things right. Counselling attracts people who care, who want to do well for others, who want to ‘make people happy’. But sometimes we can be blinded to the value of making mistakes, of having to make a judgment call in a fuzzy situation. Black and white decision making is so much easier!

Self-care isn’t all chocolate cake and scented candles (as pointed out in an article I shared a month or two ago). In this context – of whether or not to cancel appointments – it’s not all about feeling sorry for myself and curling up under a blanket. Even where I may have felt anxious in anticipation, often I feel energised after a client appointment – something about being so focused on the client, about the privilege of sharing their world, about the magic that happens in therapy. Is depriving myself of that feeling self-care? The total focus that I bring to a counselling session means that sometimes I feel as I’m ‘coming back into the world’ afterwards. It’s therefore an opportunity for me to be centred on something other than feeling under-the-weather – surely a form of self-care?

And as therapists we often feel uncomfortable talking about the reality that our work is also our livelihood – we don’t like the idea that we’re charging people a fee for ‘being nice to them’. (NB: GuthrieTherapy recently helpfully reframed this as “therapists are people you pay to teach you how to care for yourself”.) We need to make a living, and I would be dishonest pretending that potential loss of earnings isn’t a factor – financial survival is self-care too. There’s a practical business aspect to this though: we need to be good enough therapists otherwise our clients won’t come back. If we’re putting ourselves under pressure or making a habit of working when we’re not up to it, that won’t help the bottom line.

All of the above comes with the caveat that we need to not push ourselves to extremes – either of overwork or of self-care! As an example; today I felt I was functioning at 85%; I went ahead with the appointment; I did feel I had more energy afterwards but I knew also that I had recovery time, a buffer of a few hours before the next client.

I have worked in jobs where I would go in when I was feeling rubbish – ‘presenteeism’ we called it in the HR world – because there was stuff that I could do that took less of my energy, and because I felt I had to look like I was keen. I’ve also worked in jobs where I really needed to be 100% fit to cope with the demand of the role. Being self-employed the only person I’m fooling is myself and I just need to make a judgment and make the best of the situation.

As a therapist part of my work is modelling behaviour to the clients I work with. What am I modelling if I feel like shit and go to work anyway for the sake of my client? That the other person is always more important than the self, that I have to rescue them? Instead I need to check each day as it comes with the information that I have; am I fit enough to work? And check at the end of the day; was I a good-enough counsellor? If some days I decide I would have been better taking the day off, that’s information for the future. And that way I’m modelling what it is to be human, that there are very few black and white decisions and that being human is good enough.

***As a footnote: the week after I wrote this, the bug really kicked in, totally flooring me. At one point I started to wonder if I would ever be well again. This was a good reality-check to my musings; there was no way I could have worked in that state – I could barely even think, let alone ‘focus on my client’. It was a reminder that sometimes there are black and white decisions!

References: Kevin Guthrie https://www.facebook.com/guthrietherapy/photos/a.845794862156054/2040954505973411/?type=3&theater , Brianna Wiest https://thoughtcatalog.com/brianna-wiest/2017/11/this-is-what-self-care-really-means-because-its-not-all-salt-baths-and-chocolate-cake/?fbclid=IwAR0mhoAchqyad-4LLCtZfKfSlfE1cua3CvGxff6Qn5xveLjHvbjmbPRVzdM

Why can’t we let ourselves be sad?

Listening to the inner critic.

I had a conversation with a friend around New Year. We had both had periods during the festive season where we had been feeling sad in some way. Sad – what a lot that word contains. My friend used the words ‘sensitive’, ‘spiky’. My memory is of a mood of suppressed rage.

Two things occur to me now as I reflect on our brief chat. One is that I was really glad that she felt able to tell me. The second is that I felt relief that I wasn’t the only one that felt like this. You might think that, in my line of work, I would be well aware of the difficult feelings people experience over Christmas or holidays or family gatherings – and I am, more-or-less. Why were my social media posts, in the run-up to Christmas, so full of exhortations to self-compassion and the need to make space for yourself? Because I hope to remind and reinforce that belief in me, too, by reminding others! But although I am – these days – able to reflect on my responses and emotions at difficult times with more kindness, I am still learning……and I don’t always catch myself in the moment and give myself permission to feel whatever it is I’m feeling. Minute-to-minute kindness? Not quite.

However, one way that I realise I have changed is that my question, reflecting on my festive bad moods (Festive Bad Moods! I must remember that as a tagline to celebrate next year), has shifted from “Why did I feel sad?” to “Why can’t I let myself be sad?” and this is a really important difference for me. Lots of people come to therapy because they want to understand WHY they think / feel / behave as they do. I understand that, of course I do – I want to know those answers myself and just because I’m not asking that question today doesn’t mean that I won’t get frustrated by it tomorrow. But I also believe from my own experience that 1. You might never know and 2. Even if you do get the answer, it’s not necessarily The Answer. Even if you can pin down a cause, it doesn’t change how you feel……….only experiencing things differently, and lots and lots of practice, can do that. The answer to “Why did I feel sad?” in this case, was: I just did. And that’s OK; but I didn’t remember that at the time.

In my Transactional Analysis training, one of our core bits of theory was around “racket” and “authentic” feelings (English 1972). “Authentic” feelings are fear, anger, sadness and joy, each of which has a useful function in our lives (e.g. anger is what we use to tackle a barrier to where we want to go). “Racket” feelings are those which we have learned to use to ‘cover up’ the original feeling, so for example, if anger was considered an unacceptable emotion when you were little, and you got into trouble for being angry, you may have developed a coping mechanism whereby if you were angry, you would cry and get comforted for being sad. So over time you learn to overlay anger with sadness, such that as an adult, your response when someone treats you badly is to feel sad. You may never feel angry at all. (That’s not to say one feeling is more ‘real’ than the other, but words are imperfect and so we make do with what we have.)

I love this piece of theory and have spent hours trying to puzzle out exactly how it fits for me, and why, and trying to remember scenes from my childhood as ‘evidence’ for this…….and yet. And yet, although it helps me understand myself more, I still find myself in situations where I feel what I unconsciously label as ‘bad’ feelings, and try and suppress them, which often ends in me feeling worse. I get less of an emotional ‘hangover’ from this than I used to because I understand why I do it. But there is still something going on, around trying to change my feelings, which feels judgmental.

I truly believe that there is no such thing as a bad feeling…..but there’s a little part inside of me that’s not always convinced when I apply that to myself.

So now I’m trying a new tack which is more about acceptance. For me, this is enhanced by Focusing, which is a body-centred practice where I bring awareness to feelings and sensations that are going on in the background. The key with Focusing (which you can do alone or with a companion) is learning to ‘sit alongside’ uncomfortable feelings rather than trying to change them. This process in itself allows the feelings to shift and become less uncomfortable because they’re no longer vying for attention or feeling unworthy. This for me is also an important way of allowing the fears of my inner critic (which after all, is only looking out for me) to be voiced. Focusing is what works for me; I guess other people use mindfulness practice, or meditation, or spiritual practices of other sorts that work for them.

Mind you, it’s hard to break the habit of wanting to ‘figure out’ or fix; a lot of the time I am paying attention to that part of me that wants to figure out…… before I can pay attention to other stuff. But there is something really key about the experience of allowing uncomfortable feelings, that helps, that is part of self-compassion, self-care……….something about not trying to make yourself change, in order to allow yourself to change. Permission rather than pushy parent.

So I think, actually, the title of this blog should have been “May I let myself be sad?”

References or other sources of information: English, F. The substitution factor: rackets and real feelings. TAJ. 2:1 1972; https://psychologymuffins.wordpress.com/2014/03/26/racket-feelings-in-transactional-analysis/; Focusing – https://focusingresources.com/or http://www.focusing.org.uk/