24th March 2018

How a crisis can affect what we need from therapy or counselling.

How a crisis can change what we need from therapy or counselling. (c)KarnSieger.com

A personal crisis can hit you whether you are in therapy or not. How can a crisis affect what you need from therapy and your therapist?

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 being a client in therapy 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.

Emotional Chaos

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?

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 took boundaries very seriously, with no contact between sessions, unless really necessary. 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.

What shall we talk about today?

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.


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.

What approach will help best?

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.

Why CBT alone would not have helped me in a crisis Read More


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.

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.


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. What counts most for me is self-awareness, integrity, authenticity, honesty and humanity.

As a client I’d rather be with an honest and humble person, then someone who pretends to know it all.

Gratitude helps healing the soul Read More

Image courtesy of PublicDomainPictures

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