Whether you are a client in therapy or a therapist, a personal crisis will impact you, however well prepared or clued up you are about life. How can a crisis affect therapy?
Depending on which chair you sit in, a crisis will affect your needs from therapy and your therapist, or how you work as a therapists.
A crisis can come in many shapes and sizes, and can affect some or all areas of our life and wellbeing.
One of my biggest crises while a therapist and a client in therapy myself (*) occurred when I was diagnosed with cancer in 2012. You don’t need to have been affected by cancer, indeed any health-related crisis, to know how a crisis can change us, short-term or long-term.
1. A crisis can affect us in many ways
In terms of our hierarchy of needs, we may slowly or very suddenly experience a fundamental drop down to the very basic (eg physiological) needs.
Our sense of personal safety may feel compromised in several ways: physically, relationally, socially, financially, spiritually.
Life can become very uncertain: What will happen? Can I cope? Who will be there for me? Will I survive or will I die?
Our lifestyle may need to be adjusted a little or a lot. Our physical and mental abilities may be compromised. Daily routines around work, commitments, responsibilities, self care and wellbeing are challenged and can no longer be maintained in the same way. Indeed, some may need to be let go off altogether.
When life is turned up-side-down emotions do not oblige in a neatly fashioned order. Feelings can be chaotic, unpredictable, frightening. We may not know ourselves any more and doubt our own judgment.
At times of crisis we may become more irritable, frustrated, angry, less forgiving or accommodating of issues that have bothered us before – in relationships, at home or at work. This can lead to more outright conflict and / or isolation.
A crisis is a lonely time in our lives.
What is it all about
We may ask fundamental questions: Why? Why me? There may be anger, guilt, resentment, hopelessness. Beliefs and a world view that may have grounded us before may no longer contain our new experience. This can be very frightening.
Depending on the nature of the crisis there may be trauma – when it happens, or throughout. Treatment for an illness or injury, can also be extremely traumatic and affect us long-term. Sometimes we only realise the magnitude of the trauma after the event.
These are just some areas in which a crisis can affect us.
2. What did I need as a client? And what does it mean for my work as a therapist?
Consistency, predictability as well as flexibility.
As a client starting cancer treatment, I could no longer follow the routine session schedule. But I needed the reassurance that my therapist remained available for me and was willing to be flexible.
My therapist was always extremely boundaried, with no contact between sessions. That made me feel safe. On the day of my diagnosis he was on his summer holiday. However, he offered to have his phone switched on that afternoon for me to contact him. I did sent him a text, and he offered a call. But I did not need that. Knowing he was there was essential and important for me.
As a therapist this means being clear within ourselves and with the other about the level of flexibility we can offer (including home or hospital visits, email or telephone support and cancellation policy). We need to review and be prepared to adjust boundaries in a way that is beneficiary to the client and we are comfortable with, too. The most important point is to be clear, transparent and jointly agree and review.
What shall we talk about today?
As a client my crisis changed what I needed to talk about, and I needed space to just talk. I needed a neutral witness to my turmoil. But I also needed practical help.
My therapist spent more time on listening than his usual challenging or reflecting back. But I got less help with practical questions for support, eg books, alternative therapies. I felt a bit disappointed and let down. And it is the one area, where I am unsure, why he did what he did (or did not) do. Luckily for me, his approach paid off. Because I was forced to work things out for myself, and I had energy and time to do this. And in the process I grew as a person.
As a therapist this means to realize that the help clients in crisis need from us can change drastically and quickly. We need to know what we feel comfortable with and be clear what we can and cannot do. We may even need to review our contract and be explicit where changes of focus are needed.
As a client I learnt quickly that crises cost money. Illness certainly does. Within a week I became unemployed with very little coming in. I felt financially vulnerable at a time when my needs saw a massive increase.
I could no longer afford therapy. My therapist simply suggested I pay what I can. We settled on £10. I know he would have settled on 10p. I was touched, grateful and felt valued. And it made the work more valuable.
As a therapist I know that making a decent living from counselling and therapy (especially in private practice) can be difficult at the best of times. Offering reduced fees and working with client groups, who due to their circumstances may not be able to come regularly, may be ethically important to us. But it may also leave us financially vulnerable. It can be fine line between duty of care towards clients and duty of care towards ourselves.
What approach will help best?
As a client and as a therapist I learnt not to assume that just because we ‘used’ therapy or counselling approach X before the crisis occurred, that it might be the most helpful approach to continue with.
The therapy I opted for was integrative, with strong elements of relational, psychodynamic, transpersonal and person-centred therapy. It meant we could ‘switch’ a gear depending on what I needed at the time. There were moments during my treatment, when I was physically too unwell and psychologically unavailable for psychodynamic work. It would have been unhelpful and potentially destabilising. Some times the core conditions of person-centred therapy alone were enough. But overall, the therapeutic relationship, integrity and authenticity of my therapist carried it all and I felt contained.
As a therapist trained in integrative psychotherapy, I find the ability to ‘switch’ intuitively between approaches very helpful in my work. But it is not just the eclectic and multi-disciplinary nature that helps. Being able to integrate a crisis into our life, rather than letting it overwhelm, overshadow and wipe out aspects of our being – that’s where healing starts. Even if our crisis cannot be cured and even if it kills us.
As a client I felt stunned and bereft of everything held dear to me. Others were either frightened or full of pity for me. I needed my therapist to be strong for me, respectful, with hope, empathy and belief in me.
The single most important moment was when I told my therapist I had found a lump in my breast (that was before diagnosis). He did not flinch. His face remained calm, just as always. That made me feel strong and safe with him and within myself, whatever may come. Now I know, this might have taken him a lot of inner strength.
As a therapist some causes of crisis may be familiar or not. Some we are comfortable with, others we are not. It is difficult to be prepared for everything. We may need extra supervision and research new things. We may need more time out from our work to process what is happening. We may need more self care and energy, when the other needs more energy from us. I think honesty and humanity goes a long way, even if we ‘wobble’, are unsure and shocked.
3. How has my own crisis affected the way I work?
My experience has changed me as a human being and my outlook on life. Because the way I work is very much linked to who I am, my work as a therapist has changed, too.
Areas of specialisation
We all know more about some topics and difficulties than others. I have become very clear within myself, which topics I specialise in and want to work with. Over time, I have reviewed all my various directory entries and redesigned my website. Personally, I feel very comfortable supporting clients with transitions, endings, anxiety and life-changing illnesses.
This is essential for us all, and especially when we work in the helping professions. Returning to work, when, how, and with what set up – these were all important questions for me. Self awareness and monitoring was essential to work out, if and when I was well enough to return to work and offer meaningful support to others. Over time I arranged my schedule, so I have enough down-time. I have reduced the number of clients I see back to back as well as my evening work. This has come at a financial cost. But knowing what I know now about illness, self care wins hands-down.
When I became ill I had no unemployment cover for the self employed. Though I was working in the UK’s NHS Primary Care / IAPT sector and contracted to an agency which had been awarded the contract for our local area, I had no legal entitlement to any sick pay or other support. My treatment left me too unwell to take legal advice and have things checked out independently. Due to my health record now, getting adequate cover is not easy. Make sure you are covered, whichever way works best for you.
A good network
Don’t assume that fellow therapy or counselling colleagues are more likely to stick around when you go through a crisis. We are humans too, and we can disappoint as well as pleasantly surprise.
Personally, it took me a long time to feel comfortable with the idea of self-disclosing (on my website and in my writing) that I have been treated for cancer. On balance, and based on my experience, this does not get in the way of my client work. On the contrary, it can support and strengthen it. I do not always proactively mention it, and in many cases it is not relevant. My experience is individual to me and I am respectful of others’ views and needs. Being honest and open about who I am has become an essential part of my healing journey.
When a therapist has to stop working or dies
I really think we need to have a plan in place in case we need to stop working suddenly or we die unexpectedly. It should be part of our client agreement / contract: What if…? Who will tell clients and what back up system is there? I know this might not be easy.
While I underwent cancer treatment, my therapist had to stop working suddenly (and for me unexpectedly). I found out from him via email. He offered a replacement therapist, which is not what I wanted at the time, but did take up later on. Luckily I reached out to the person he suggested when I did. Because soon after I received an email from someone I did not know, telling me my therapist had died. Being supported through this awful time by someone how had known him, gave me extra support. It was a shared grief, which matters so much, as there had been no ending with him.
4. In Summary
My late therapist used to say, nothing in life is a waste.
When I talked about difficult experiences, he would often call them a gift. It took me a long time to get my head around what he meant and even longer to be able to start feeling and appreciating what he meant.
Often people think therapists and counsellors have it all figured out. I used to think that, too, and felt jealous and a bit resentful. Those were the days when I was a lot younger and knew nothing about our profession.
I just thought, whatever life throws at therapists, they will know how to cope with it, and they will know what to tell others. Lucky you, if your friend or someone in your family is a therapist or counsellor!
Alas, now I know that real life, including for therapists, is less romantic, and a lot more complex.
When I went through my cancer crisis, a lot of my therapeutic knowledge offered important tools of self help to me. Sadly, very little is available in a timely manner as part of the medical treatment model.
For me the crisis has reinforced the importance of paying attention to myself. Nothing is a waste. I form opinions, see connections, and somehow it all nourishes me and my client work.
I have started to appreciate a lot more, that none of us is perfect. We need to be good enough. It is self-awareness, integrity, authenticity, honesty and humanity that counts. As a client I’d rather be with an honest and humble person, then someone who pretends to know it all.
It will affect our needs as a client and the way we may look at how we work as a therapist.
*It is not uncommon for therapists to attend therapy. This can be an accreditation requirement, a measure of self care and personal growth and development.
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