‘Ow much?!

Despite all of the deeply personal subjects discussed in counselling, there is one issue that can often be the most difficult for a counsellor. Asking for payment.

paymentOn the whole counsellors are a nice bunch. We generally enter the profession with a desire to help people, however that looks.  So, when at the end of an emotionally charged session, we lean forward and ask “how do you want to pay today?” it can feel like a commercial intrusion into what should be an altruistic exercise in human compassion.

My first role as a professional counsellor was with the charity Relate. Even though I was asking for payment for the organisation not myself, I still almost felt ashamed to be asking. It was as if this somehow belittled the service being offered and reducing it to a commercial transaction rather than a supportive one.

As time went on and I became more used to discussing payment I began to think about this differently. Most couples seeking help recognised the importance of counselling so would happily pay the asking price. Sometimes they paid more to help us support clients on lower incomes. And this made me realise that talking about payment for counselling should be a positive and empowering experience. We are professionals, with high levels of training and ongoing commitments to professional development. Payment for counselling can be seen as a recognition of this level of professionalism, as well as a sign of the commitment of the clients to the counselling process.

In private practice it is the norm to agree payment amount and method in the first session so that everyone understands what is expected. But those first sessions are generally functional anyway, discussing practical elements of the contract between counsellor and client. This makes the money conversation so much easier. During the actual counselling it can be a more sensitive topic to raise.

Now I’m in private practice I’m obviously more aware of the importance of payment! For me to get to be the professional I am has cost me in excess of £20,000. As well as many, many hours of stress, time and effort (for me and my husband!) I aim to be the best counsellor I can, so continue to spend money on training, books, professional memberships etc. And, I have to eat too (as does my husband and the cats!) So I have to charge for my services.

So, taking payment for counselling positively reinforces the professional status of the counselling clients receive. Equally crucially it represents an investment on the client’s part in the counselling process.

Anger management

When I first started training to be a couples’ counsellor, my impression was that I was going to be dealing with a lot of anger management. I grew up in a family where rows were not the usual way of dealing with problems, and I’m generally a non-confrontational person. So I did worry about how I would deal with this.

Anger_ManagementIt is not unreasonable that at some point one or other client will be angry, and this will be presented in the room. But I would say in the majority of cases, the couple are in therapy to resolve issues and have a shared willingness to resolve their problems in a reasoned way, so we can manage the anger. In fact, it can be a useful tool to examine where the anger is coming from and how each partner reacts to and processes it. Tracking an argument: listening to what is being said and exploring the interaction with each partner really helps them to see how escalations occur and what their trigger points are.

But, there are times when one or both partners presents with large amounts of anger, easily and vocally expressed (sometimes very, very loudly expressed!) And these can be very challenging cases. In the first instance we need to be conscious of safety. If anger is being freely and overtly expressed, it is important to explore what will happen when the couple leave the relative safety of the counselling room. So checking in that anger doesn’t spill over into violence or intimidation is part of the process of dealing with it. When I work with couples where anger is overtly expressed, I will contract with them to agree at what point and how I will intervene in rows. In the most extreme cases it may be necessary to stop the session, something I have had to do on a few occasions.

I do find it difficult when clients are loud and shouty. So I monitor my anxiety levels and what the anger is bringing up for me to enable me to work with the clients’ anger in the room. Managing anger is not about stopping the expression of anger. It is about ensuring anger is expressed safely and that it leads to a resolution of feelings. This means allowing anger to be expressed without resorting to personal insults and intimidation.

A quick Google search will throw up lots of helpful guidelines on anger management and how to row safely and effectively (see here for example: http://bit.ly/2bhGbE6 ).

Boundaries in counselling

Counselling works best when there is a strong relationship between the client and the counsellor. Research suggests this is the case for all models of counselling and I think most counsellors agree it is this relationship that they work hardest to build.

boundariesWhere the various models disagree is on how much of ourselves counsellor should bring into the room. Is it OK to share personal information with a client, and if so how much? The guiding principle here is that any information shared should be for the benefit of the client and not to suit our own needs. It’s a hard balance to get right and one of the reasons professional supervision is so important.

As we work with clients, and build the relationship (sometimes over many months) it is not uncommon for the client to feel they have become “friends” with us. However you define the relationship, there is a strong inter-personal bond between us. This happens despite the counsellor not giving much information about themselves. The BACP is clear that we need to manage the boundaries around this relationship to ensure the safety of clients and that their confidentiality is protected (http://bit.ly/2a42Spc).

I work in a small town, so there is a chance I may bump into a client in our local Costa. If this happens we need to be clear about how to manage this and maintain our boundaries. On the one hand I must protect my clients’ confidentiality. So if I’m with someone and I see a client, I need to ensure the person I’m with is not aware of the client. But often clients will want to say hello. It’s natural human instinct to acknowledge someone you know. So I negotiate with the client what we will do if this occurs to ensure we respect the client’s autonomy and confidentiality.

There is another side to this. As counsellors we need boundaries to protect ourselves also. Counselling is my job, and as rewarding as it is it can be an intensely emotional experience for us too (again, hence ongoing supervision). So when I’m not in the counselling room, it may be that I don’t want to talk to my clients. This isn’t a rejection of them as a person, it is an acknowledgement of our professional relationship. It is important to help me remember the client is exactly that and not a personal friend. This is essential for me to help me maintain my sense of neutrality with the client and not get drawn in to giving opinions, or even worse…advice! That is strictly the role of friends and family, not counsellors.

Let’s talk about sex

In relationship therapy we will pretty much always ask about the sex life of the couple at some point. So it was no great surprise to read that a recent study has found that 34% of men and 44% women have experienced problems in their sex lives. http://bit.ly/2ahfDkE

Whilst these figures in general are high, what is even more surprising is that these figures relate to young people aged 16-21, showing it is not just older people who have issues with sex.

talk_about_sex_screenAs a therapist what was even more worrying was the number of respondents in this study who have sought help. Only 25% of men and 36% of women had sought help from family, friends, the media and the internet. Only 8% of women and 4% of men had turned to any sort of “expert” (GP, therapy etc.) for help. Just imagine, up to a third of people asking the internet and media for help. I can only imagine the damage that is doing.

The vast majority of young people then are not asking for help about sex. It would seem we still haven’t shaken off the inherent embarrassment we feel when it comes to talking about sex.  This can be harmful as there is a circular link between sex and the relationship in general. When the relationship suffers, the sexual relationship often acts as a barometer of this. When the relationship improves this is often reflected in the sex life. So understanding what is going on sexually can help us understand how the relationship is in general.

And yet even in therapy it can often be a difficult subject to broach. As therapists we carry all of our societal learnings and prejudices about sex. One or both of the partners may find it difficult to talk about sex, especially if we need to talk about the “mechanics”. Even find a common language can be hard. Willy, fanny, vagina, penis, tuppence, dick. What are the words it is ok to use whist having this conversation?

Talking about sex is an important part of enjoying a happy sex life (in whatever way that works for you, including having no sex at all should you not wish to). Let’s hope more than 4-8% of young people start to feel OK asking for help when they need it.

You’re breaking up with me?

Sometimes, in relationship counselling, our job is to help the couple as their relationship ends. Endings can be painful, as we learn to live without someone who has been a significant part of our life.

goodbye-inscription smWe do know, however, that one relationship is definitely going to end – that of the therapist and the clients. And this ending needs to be negotiated and managed just like any other. Some models of therapy will provide an agreed, set number of sessions (mainly in the NHS, and other service providers). But in private practice I am free to counsel couples for as long as the clients want. So we need to stay alert to when the process is coming to an end and how to manage this.

I firmly believe (and the research would support the idea) that whatever therapeutic model you use, it is the quality of relationship between client and therapist that brings about positive outcomes for the client. Therapists work hard on building a relationship, and become part of the clients’ world for the time they are working.

So endings can be hard. Especially when we have seen clients move from a state of crisis to a new and improved way of being in their relationship. It is essential the client is able to say when they think the process is over. It is not the job of the therapist to tell the clients they are “cured” and no longer need counselling. But it can be scary for clients to think about ending as they fear that without the support of counselling they may slip back into old patterns of behaviour.

One danger is clients continuing to come to counselling, but just using the session to re-hash petty arguments. Or they start to create “issues” so they have something to talk about. In private practice there is also the danger that the therapist may not want to let go of a steady and regular income stream, and collude with this extension of the sessions.

The therapist and the clients need to spend time thinking and talking about how the clients will know when the process has ended to avoid this happening. And address concerns about how to identify old behaviours and what to do when they occur. Most importantly, we need to be honest with each other about how we feel about this and acknowledge it is an “ending”, and what the emotional impact of this will be.

Counselling and split agendas

Couples attending counselling can be there for a huge range of reasons. In my initial meeting I’ll generally ask the couple what each wants out of the counselling. Sometimes they don’t really know, and more often than not what they think they want at the start of the processes isn’t the same as what they want at the end.

What can be really challenging is when what clients present conflicting agendas: “I’m here because I want to save our marriage!” …. “I’m here because they won’t accept its over and I want to move on!”

When I was a counsellor in training, one of the first couples I saw presented in this way. I can still recall the look of realisation, then devastation on the optimistic partner’s face, as she realised the relationship was over and there was no going back.

The point of relationship therapy is not to “save” the relationship at any cost. What we aim to do is work with the clients as they try and determine for themselves what is the most acceptable outcome. This may be staying together roughly as they are, or staying together in some re-negotiated way. Or, it may be separating. When both partners agree separation is the right thing we can then focus the work on how to achieve this in the most constructive way.

When each partner has a different view, things can get complicated. The therapist has no opinion on what is the “best” solution, so needs to balance the competing ideas, beliefs and feelings of each partner. The most challenging of split agendas occurs when one partner simply doesn’t want to be there. Counselling works best when there is commitment to the process from all parties. When that doesn’t exist, it’s hard for any therapeutic change to occur. So not only is the therapist managing split agendas, they are trying to work with someone who actively doesn’t want to do the work.

Whatever the clients’ expectations of the outcomes are, these sessions are draining and can leave me feeling like a “failure”. As a therapist I need to reflect on my role and feel reassured I did all I could. I find comfort in the belief that we each do the best we can with the resources we have, and the clients will find a way to manage their relationship in the future, whatever it looks like.

Oh, baby

So, according to Andrea Leadsom only people with children can be invested in the future of our country (http://www.theguardian.com/politics/2016/jul/09/andrea-leadsom-told-to-apologise). These comments have caused something of an outcry, with many people quick to point out even childless people have nephews and nieces etc. who will go on to live with the country we are forging today.

But what about people who don’t even have nephews and nieces? Are we somehow exempt from having to make decisions about things that will endure after we have shuffled off this mortal coil? I find this an uncomfortable thought: that childless people have such casual disregard for other people that we will not be engaged in the future unless our own DNA is somehow part of this future.

As a relationship therapist I regularly see couples who don’t have children, especially working with the LGBT community where there are still (for many reasons) more childless couples than amongst heterosexuals. But I don’t think I’ve ever seen a childless couple say they have no interest in the future. Or that they give no thought to the consequences of their actions as it won’t matter when they are dead.

ChildfreeSo what does this tell us about how society views childlessness? Leadsom has now apologised for causing any hurt to her rival, who apparently wanted children but has been unable to have them. So are childless couples to be seen as objects of pity? Is having children such a biological imperative that we cannot conceive of people living happy and fulfilled lives without children? And how does this play into the narrative that same sex couples shouldn’t be able to have children?

Within couples there can often be a tension about children, whether to have them, when, how many etc. It is often these powerful narratives about the need for children that drives the tension in the relationship. It is also a fact that within our current culture women will still be the principle care giver, with all the career and life altering implications this has. What relationship therapy can offer is a chance to explore these notions about children and so help clients make choices that are not just re-enactments of generations of scripts about our purpose in the world. Instead their decisions will be the right choices for the couple, and the future of society.

Betrayal and Relationship Therapy.

In the weird and wonderful world of Westminster, betrayal seems to be a way of life, as Boris Johnson found out last week when his chances of running for prime minister were scuppered by his “friend” and ally Michael Gove. They make an unlikely couple, but would counselling help?

Michael Gove and Boris Johnson (right) on the Vote Leave campaign bus in Lancashire, as part of the Vote Leave EU referendum campaign.

Michael Gove and Boris Johnson

Whilst par for the course for career politicians, betrayal is not something most couples will expect to have to deal with. And when they do it can be devastating. The very word itself is so powerful. This isn’t just “you’ve upset me”, or “I disagree” or “I didn’t like it when you did that”. This is earth-shattering stuff. This is loss of trust on an epic scale. This is a rejection of what we consider to be the fundamental core of both ourselves and our relationship.

Relationship therapy can help by examining the context in which the betrayal occurred. What else was going on in the lives of each partner which lead to the act and how does this help us understand what happened? Let’s be clear, the partner who has betrayed the other needs to take responsibility and understand the impact of their actions. But simply pointing the finger and blaming may not be helpful in enabling both partners to move past the hurt and anger. We know the act happened, we now need to know why. And if it’s because the betrayer is a sociopathic bastard with no moral compass, then we need to know this so the betrayed partner can decide if and how they want to have a relationship. But usually it’s not that simple. The betrayer is a human being and like all human beings they are subject to; weakness, confusion, persuasion or just downright stupidity from time to time.

Having worked with clients who have “betrayed” their partners, I have seen their pain as they have considered in turn the pain they have caused others. I have seen clients struggle as they realise the devastating impact of their actions on their partners. Holding this realisation and allowing the hurt partner to see it is a really important step in moving towards a resolution.
Working with betrayal is one of the hardest jobs we have as a relationship therapist, due to the levels of hurt and anger often brought into the room. Working with clients who have experienced betrayal can help them find a way of choosing how they want to respond to it. This may be accepting and forgiving, or ending and moving on.

Whatever Boris and Michael choose to do next, they will need to find a way of managing their professional and personal relationship. For the rest of us, relationship therapy can really help when we are faced with making such difficult choices.

Couples counselling and managing difference.

Unless you’ve been living on the moon, you can’t have helped but notice we have had a referendum recently. Whichever way you voted (or didn’t) the result of this has been a clear and marked division, pretty much straight down the middle of the country. Maybe what the UK needs now is a huge group session of couples counselling?

What has been interesting is the emotional response to the outcome and the way in which friends and families are finding themselves struggling to reconcile their differences. Rather than a clear, rational and logical discussion about facts, people who would normally consider themselves friends are hurling insults, making accusations, and worse of all unfriending each other on Facebook!

The country now has a difficult journey to try and reconcile these opposing ideas and find a way for people to accept their differences. On a smaller scale, struggling to accept difference can often be what brings people to couples counselling. When people meet they can be attracted to each other for all kinds of reasons, some overt and obvious, some more deep or subconscious (if you want to know more about this See Henry Dicks’ book Marital Tensions for a fuller description of “Couple Fit”). Couples find ways of living with the differences they have, much as most people accept friends on the left and right of the political spectrum.

So what happens when these tensions suddenly seem unbearable? When you feel the ideas and beliefs a person holds are absolutely incompatible with your own? As the country grapples with this problem, so too do couples. Sometimes the differences which were so attractive early in the relationship become the things that irritate and annoy the other. Dealing with these differences is made harder as each partner has an emotional attachment to their beliefs. So an attack on the beliefs isn’t perceived as a disagreement with the other’s point of view, it is seen as an attack on the core of the self.

When emotions come into play this way, as with the referendum result, we resort to an attack and defence cycle where hurtful and emotional comments and behaviours take the place of debate. For many couples attending counselling, this is the cycle they find themselves in. The relationship therapist’s job is to help the couple find a way to stop this cycle and learn to once again celebrate each other’s differences. It’s a tall order on the macro scale of a country divided, but couples counselling can be really effective when working with a couple on their specific issues to help them recognise what they want to change, and how to celebrate the differences which make them stronger.

Relationship counselling and managing change

If there’s one thing we can be sure of, it’s that things change. During relationship counselling, I see these changes happening, as couples deal with changes which affect them as a couple, and also as they grow and change as individuals within the relationship.

Whether we like it or not, life has a habit of changing around us. There are many people for whom change is a tonic. They welcome it with open arms, even seek it out. Some people like change so much they make it happen, looking for new adventures and opportunities. They upset the status quo, fear stagnation and scoff at stability.

But for other people change is a source of stress. These are people who will seek to maintain the status quo, who will avoid life changing decisions and do everything they can to make things stay as they are.

There’s nothing wrong with either position, it just depends who you are and what you want out of life. But the pressure comes when we find ourselves in the position we are less comfortable with, or when we are in a relationship with someone who doesn’t share our approach to change. This is one of the main reasons clients come to relationship therapy.

I’ve recently had change thrust upon me, and as a natural risk avoider it’s not been easy to deal with. I’m fairly good at using denial as a defence mechanism, so my head disappeared into the sand quite quickly! But this only worked for a short time. At some point we have to face the reality of our situation. Stick or twist.

Counselling can help of course. Talking to someone about what you like about your personal approach can help you understand why that’s the best place for you. In turn this can help you explore if there are other options, other ways of being.

Couples often find they approach change at different rates and this can cause stress in a relationship. As change happens, each partner will be in a different place. One may be ready for change whilst the other is not even acknowledging it. Relationship therapy can be really helpful here. The therapist can work with the couple to bring a shared understanding of change and how each can help the other move through the process.

The change may be external to the couple, or a change in the couple themselves. Life events (babies, new jobs, growing children, retirement) all challenge a couple to re-think how they relate; both to each other and to life as a couple. Couples Therapy is all about change, and counselling can help each person manage this process.

So, agent of change or stick in the mud? Or is the reality that we’re all a little bit of both. Either way, help is out there!