Author Archives: Dee Howe

We are all having very different experiences of the effects of coronavirus but there are many which are shared that go to the very core of being human. In general, humans are naturally sociable beings who thrive on personal interaction with others being physically present in the same space.  It is valuable being able to maintain ‘virtual’ contact with family, friends and acquaintances, but it is not the same; something is missing from the lack of physical presence.  Either from home or outside home, the silence is deafening from the lack of chatter of people being together and it seems unnatural to step away from everyone around you apart from those you live with.

Those of us who retreat into a bubble to try to cope with what is going on around us are not alone.  Many are fearful and anxious about the effects of coronavirus on themselves and their loved ones and the near, middle and long-term future looks a scary place.  For those who have existing anxiety and depression, the suffering is multiplied.  The impact of the policy to keep washing your hands can have a negative impact on those experiencing OCD ( Obsessive Compulsive Disorder), both on those who have managed to find effective coping strategies and those still struggling to find a way through.  Both groups are experiencing a serious set-back.

My counselling and psychotherapy business has needed to adapt in the lockdown and work with clients continues by Skype.  It is a more restrictive way of working, clearly not the same as sitting in a counselling room where we are physically present with each other.  However, we are still able to have valuable engagement through the combined visual and audio contact and achieve the level of progress that we were able to in the counselling room.  ‘Virtual’ counselling seems to be ‘good enough’ and as such should be valued as an effective resource of support for those with emotional, psychological, physical and any other wellbeing needs.

An increasing number of clients who I work with are struggling with gender identity issues. Although acceptance is growing in society that sexuality is no longer binary, it is early days in the process of changing attitude and there is still a long way to go. Clients come to counselling with self-doubt and lack of confidence about who they are. They may have difficulty understanding why they are different and coming to terms with this difference, believing there must be something wrong with them. Some take on homophobic views, as a mask of shame and indication of their internal turmoil.

The difficulty is two-fold: how clients are perceived by others, friends, family and society and how they perceive themselves. The main focus of our work is to help clients change how they perceive themselves, stop being judgemental and hard on themselves and fully accept their gender identity. The work involves reducing and, with time, ending self-doubt, shame, their sense of isolation and habit of shutting down and not honestly communicating their thoughts and feelings. These negatives are replaced by increased self-confidence, honesty about who they are to themselves and others shown by a desire to communicate more openly. Most significantly, clients find a new inner peace, longed-for happiness and greater ability to fully participate in everything going on around them.

The importance of empathy in the therapeutic world is undisputed, it is fundamental to good practice by counsellors and psychotherapists in their work. It is also core to all other relationships. There is an assumption by most, seeing ourselves as compassionate human beings, that we show empathy towards others but, sometimes, we have blindspots which go some way to explain difficulties in relationships with others. This can be seen in clients who present with work-related issues with colleagues where, through exploring, we discover that because of factors such as target pressures and low self-confidence they are less empathic towards others. It can be hard to accept but, when colleagues’ feedback shows a consistent pattern of feeling unheard and unvalued, it is essential to do this so that steps can be taken to introduce change and improve working relationships.

It can also be difficult to acknowledge lack of empathy in others who you love and value deeply but who show uncaring behaviour towards you. Many clients in abusive relationships who I work with are quick to blame themselves for issues in their relationship with their partner. It is more difficult for these clients to see that their partner is not being empathic towards them as this leads to shattering their belief of being valued and loved. It is hard to let go of the illusion of mutual love, value and acceptance but, in more accurately assessing the situation, this can lead to making better self-protecting decisions whether that involves staying in, or leaving, the relationship.

We all need to put empathy in the spotlight to assess more accurately whether we are meeting our needs both for ourselves and for others.

I have noticed in my practice an increase in clients bringing issues relating to eating disorders. I wonder whether this is because there is an increase in the number of people suffering from eating disorders or an increase in awareness that problems they having been experiencing have a name to them.

The focus on food in society can be seen everywhere, such as in advertising and the rising number of screen programmes on cooking. It is positive to have access to a wide range of information on healthy cooking and healthy eating. However, it can have negative consequences. An example is when clients embrace calorie counting to such a degree that it becomes all-consuming. Rooted in issues such as low self-esteem, lack of confidence, anxiety and depression, this can become a toxic mix.

The central issue for the client is often one of control. Food becomes a refuge as perhaps the only area of life over which a client thinks that s/he has control. The reality is that food has control over the client. The amount of time spent in a day thinking about food becomes disproportionate and becomes a major part of decision-making about the structure of the day. Such focus on food interferes with clients’ ability to be fully ‘present’ and to derive enjoyment from their experience of what is going on around them.

The counselling work involves helping clients explore and understand better their relationship with food so that they can regain control over it and have a healthier relationship with food. The aim is to work with clients to reduce their focus on food and allow greater space to focus on non-food related activity/ies from which clients can derive enjoyment and achieve more balance in their life.

In my practice I see clients who seek help with a variety of issues where the work involves a form of ‘life coaching’. There are clients who want to become more assertive either in their family unit, at work, socially or generally. In the counselling room we explore various situations/scenarios which clients wish to handle more effectively and we work out new, different ways of coping which have more productive outcomes for them. Between sessions, clients try to put into practice what we have discussed and we review how they get on in the next session, learn from that and look at continuing with those strategies and/or working out further ways of encouraging sustained effective assertiveness. Over the course of time, varying in each case, clients develop confidence in their ability to cope. This type of work is informal ‘life coaching’ yet it is an essential part of the counselling process.

Other areas of counselling work involve ‘life coaching’ as an integral part of the counselling process. For example, anger management when the focus of work is to find more effective ways of being for clients where there is tension and conflict. Depression, when there is a need to work out changes in life style, including nutrition, diet and exercise, to encourage fuller participation in activities, social relationships and work. Also, eating disorders where more effective strategems are needed with regard to exercise and buying, preparing and eating food to promote more positive, balanced well-being.

Life Coaching is a specialist field with the requirement of specialist training, qualifications, experience and practice. However, it can be argued that, informally, at some level, counsellors may deliver a life coaching role to their clients and, in this way, life coaching is not separate from, but can be regarded as an important part of counselling.

We are nearing the end of another academic year, with the summer term just beginning. I practice near my local university and it is interesting to reflect on the nature of my work with those involved in university life which clearly shows that both students and providers of university education along with those involved in research projects experience massive stresses and strains.

For undergraduate students, university may be their first time away from home and involves a huge adjustment in terms of self-organisation, self-responsibility and self-reliance. Some thrive but others find it difficult, feel homesick, lonely and isolated, with low levels of confidence and self-esteem.
For postgraduates, the intense rigours of academic assignments and funding issues can weigh heavy and mean that there is little time left outside work for beneficial, de-stressing activities.

Pressures for lecturers who combine teaching with research which involves publishing papers, articles and books to secure funding, lead to a heavy workload. Life outside work can be largely put on hold. Stresses in relationships with family, friends and colleagues can arise. This seems to be a similar situation to those I have worked with who are researchers at university.

It can be argued that those involved in university life, whether as a provider or receiver of education or researcher, are fortunate but as a result of the intrinsic stresses, competitive nature of their roles and pressures on securing funding, there can be a detrimental effect on their emotional, psychological and physical wellbeing.

Counselling offers a means of addressing these stresses and strains and clients express the value of receiving counselling in an independent, confidential setting away from the university campus.

Counselling is principally a talking therapy but many clients understandably find it difficult to talk about their innermost thoughts and feelings which may have been buried for many years and are overwhelmingly painful to start to look at. Particularly where clients have never discussed such difficult experiences before and find themselves one-to-one with a counsellor, someone they do not know. Creative techniques such as stone work, drawing, imagery, writing and music can be of great benefit to the counselling process. They offer clients different ways of expressing what they feel and think, providing a direct route and immediate connectedness to inner parts of themselves that they struggle with.

Some helpful, creative techniques include:

(a) Stonework

An example of stone work involves a client picking from a collection of stones those which represent how they are feeling, how they would like to be feeling and significant others in their past and present. The way they can be set out in relation to each other tells one a lot about closeness and distance in given relationships.

(b) Drawing

Drawing in counselling is not about artistic skill and I often need to reassure clients about this. In the counselling room, a client and I learn a lot about what the client is experiencing from whatever form the drawing takes; it’s about size, placement, choice of colours and tones as much as the detail of the piece.

(c) Imagery

It seems to be quite natural for many clients to think in images, to visualize images which reflect how they feel about themselves and others. Such images vary widely and include living, non-living, abstract things for example animals, fable characters, objects, landscapes, elements of nature. Working with these images can provide great insight into a client’s inner world.

(d) Writing

Writing can be helpful both in sessions and between them. It is important that in sessions a client takes responsibility and does the writing rather than telling the counsellor what to put and letting the counsellor undertake this task. In the same way that drawing is not about artistic skill, writing is not about writing skill and clients often need reassurance about this too. Through writing, a client can clarify confusing thoughts and feelings, particularly with the benefit of being able to see something written down as a record to refer back to. Where a client experiences deep-rooted anger towards another, expressing this anger in writing can be cathartic and enable a client to let go and move on.

(e) Music

Both in sessions and between sessions, music provides a client with another way of acknowledging painful thoughts and feelings and working through them.

I encourage clients to look on creative techniques like those above as a means of enhancing our counselling work and not to be wary of them. These techniques are complementary to, rather than in conflict with, talking therapy.

There is much debate over the value of CBT (Cognitive Behavioural Therapy) especially since primary care counselling is now provided nationwide by the IAPT (Improving Access to Psychological Therapies) Service. The IAPT Service promotes mainly the use of CBT for depression and anxiety, as recommended by NICE (The National Institute for Health and Care Excellence) largely because of the CBT core features of strong evidence-base work and concrete measurement of outcomes. CBT targets negative thoughts, with a set structure to sessions involving sheet work and between sessions homework. The idea is that change in thinking will lead to change in /reduction of/elimination of connected negative feelings and behaviour(s).

I received training in CBT in 2011 on a Post-Qualifying Certificate course run by The Iron Mill Institute, Exeter. Since then, I have incorporated my CBT skills into my counselling work when it seems appropriate and each time in a flexible, individual way. I am an integrative counsellor, using various approaches, and the importance of the therapeutic relationship is fundamental whichever approach I use, including CBT. My CBT work with clients is collaborative and I believe empathy, warmth, non-judging, valuing and accepting are vital for establishing a strong working relationship with the client. The CBT work is embarked upon sensitively with the aim of empowerment for the client.

However, there are difficulties in using CBT as experienced by clients and observed by me. The force behind CBT is applying logic using an evidence-base. In the pursuit of tackling negative thinking, there is a risk that feelings may be left behind, not given space to be properly expressed and explored. Clients can come up with new/alternative balanced thoughts and as an intellectual exercise give a new lower rating of connected negative feelings, but this can be no more than a paper-exercise when a client says “but I don’t feel any better/different”. This clarifies the underlying need to explore the client’s feelings and experiences using a different, Person-Centred approach.

Using CBT can feed a client’s issues rather than resolve them where the client’s comfort zone is his/her head rather than heart. Those who find it easier to express thoughts rather than feelings may well through CBT be able to escape the more difficult but arguably more important realm of exploring and working with distressing feelings.

Telephone counselling provides a valuable service to those who are house-bound through physical illness/conditions/disabilities or other conditions such as severe depression or agoraphobia. The client may be in an abusive relationship where control or fear is such that the obstacles to visiting a counsellor are too great. Dependency on others for transport to counselling rooms, living in a remote area and restricted choice of counsellors in the locality may be issues. There are those whose work pattern makes it difficult for them to make time to go to see a counsellor. There are also those who prefer the anonymity of work by telephone where they are not seen.

My experience shows me that the nature of the work is very different. Not being able to see the client poses difficulties. There is a temptation to make an assumption about appearance which is faulty and to make other erroneous assumptions from tone of voice and language content. The usual visual clues in the counselling room of facial expression and body language are not available so that you are unable to see the client’s visual response to what you are saying. With the protection of anonymity, the work can quickly reach a more intense, emotional depth and at the end of a session I often feel more drained than in counselling room work. The freedom and power of anonymity means clients can say whatever they like which can be positive in an empowering way but there may be negative disclosure for example about risk of/ actual harm to others which the counsellor is powerless to act on. Clients can end the session at any time by hanging up which gives them control but can leave the counsellor with ambivalent feelings brought on by the abrupt suddenness of it. In terms of my way of working, we are not able to use any visual methods or techniques such as written exercises, art work or working with stones.

There are counsellor concerns about where the client will be during the session, whether in privacy or whether there are likely to be interruptions and how the client will cope with those. At the end of the session, particularly when it has been at a deep, emotional and complex level, the counsellor will be concerned to know how the client will look after him/herself. Whereas in the counselling room, the client has to physically leave the room and building before adjusting to the rest of the planned day, after a telephone session, there may be no time for ‘coming to’ before continuing with the demands of the day.

The nature of the work seems to be less of equal partners. My experience is that the client has more power in the working relationship which may have a positive effect in terms of the client’s self-esteem, confidence and assertiveness. For me, without the aid of visual clues, visual methods and visual techniques, I can at times feel somewhat de-skilled but it makes me focus more attentively on how I am really hearing what the client brings and in this way enhances my working practice.

In an age of technological advances, opportunities for counselling work extend beyond the counselling room. Skype is an effective way of being in touch with others wherever they are, all over the world. I have been able to counsel clients outside the UK, something I would not have thought possible in my early days of work.

However, there are difficulties inherent in this means of contact, such as technological ones when ‘the line’ goes down mid-session. Also, there is the important issue of eye contact. When you and your client speak, you are both looking at the camera attached to/inbuilt in the computer/laptop device and do not have direct eye contact with each other. In the moment of speaking, as you do not see the client, vital visual messages and clues given by the client are lost. Despite this, counselling outcomes can still be achieved and for many clients it is a preferred way of working.