A wait is over

For those of you following along on Twitter, you might have seen that my confirmation email came yesterday; I passed the exam board. I am now a qualified counsellor/psychotherapist with a PgDip in person-centered counselling and psychotherapy. 

And now I am waiting to see a client- my first client as a qualified counsellor. It is an odd feeling- like riding a bike without stabilisers. In reality, not much has changed; I haven’t been to my training institution since June (the end of term) and my cohort had their first week of their last year a couple of weeks ago. I have the same supervisor, the same clients, the same room. But here I am, fresh and new. I have done many counselling hours (well over twice that of a level four trained counsellor), but I am about to do my first hour (or possibly get my first DNA) as a trained counsellor. There is something different in that. 
In many ways it’s full of possibilities. In other ways, it is stagnant- this is my counselling service (there are now seven of us affiliated with it, including me) and that I guess isn’t something a trainee usually does. But I saw the gap and I made it work. We have three working counsellors and a waiting list. I’m not moving ‘on’ to anywhere- this charity is what I want to spend a good long while building. That’s why ‘stagnant’- change happens slowly. We are waiting for charity status to be awarded so that we can move forward to the next bit. And the next bit and the next bit. So still, a lot of waiting. 

I was very relieved when I got the email confirming. I entertained thoughts about it all going wrong at the last moment, of course. But it didn’t. Everything is fine. 
I’m taking a couple of weeks’ break here and next week will probably be the move to the new name (as yet to be thought of!) whilst I ponder my new direction.

(how) Do you see me?

This is the second of two or three (I haven’t decided) parts about the BAPCA conference.

In the lead up to the conference, it occurred to me that it might be an interesting idea to get BACPA to challenge some assumptions and at the same time, help me personally, and so I sent an email and asked if, on people’s name badges, it could look like:

NAME
Pronoun……

After some explaining about what this meant, and that it wouldn’t be ok to write ‘pronoun: he/she/other’, with two people who both said ‘yes this seems ok’, I was excited and hopeful that for one weekend, I would immediately be known for who I was and wouldn’t have to explain myself to everyone (although I foresaw some conversations about my choice of pronoun). When I got to the conference, I cannot describe the disappointment I felt when I realised that the badges just said NAME on them. I was crushed. This was a conference on diversity, supposedly at least in part for and about people like me, and something I had requested had been theoretically agreed to but not carried out. I wondered if perhaps it had been an administration error, so I asked the first person I’d spoken to what had happened. She told me that it had been discussed, and they couldn’t see why THEY would need a pronoun on their badges, and if I wanted one, I could just write one on. I responded and said ‘that immediately ‘others’ me’ and in her face I recognised that I had made sense in that moment.

I walked away, to be met by someone else who said ‘Oh – you’re the one who’s going to write ‘they’ on your badge aren’t you? you need to tell me about that, because I don’t get it’. And I kind of mumbled something and went away. I was uncomfortable with the idea of having to explain myself and just wanted to get away. I decided from that point that I wasn’t wearing my badge. If i couldn’t be fully known for who I was, on equal terms, I would be known on my terms. I felt pestered by the same person on two more occasions to educate them. I eventually flat-out said ‘no, I won’t. Please feel free to look online’.

My four days was spent never really being seen. Most people got my pronoun wrong most of the time. Some people really tried hard, and I can see that and don’t have a problem with it. Some got it right (few), and a lot more got it wrong, corrected themselves and moved on. A lot more clearly weren’t able to risk admitting potentially being wrong or uncomfortable, and so carried on (either that, or they never noticed that despite me talking about it, and showing up to the evening event in my facial hair, that ‘she’ was potentially inappropriate) and it was ‘she’ all the way. Others performed great linguistic feats to never gender me. I suspect it would have been much easier work to say ‘they’, rather than not use ANY pronoun.

I have to say, going out in the evening in my facial hair was something I’d never done before. That has previously been confined to my house. Aside from a couple of positive comments, no-one said anything or reacted externally, which was just what I wanted. It was great (both the positive and the lack of negative). I was able to relax and have fun in a way I didn’t think I’d manage, the first time I walked out of the bathroom and into public.

But it was back to ‘she’ for most of it.

Readers, those who say you’ll work with LGBT clients, have a think. It’s not enough to think you’re accepting. When you get it wrong with me it’s ok; I’m resilient. When a client who has never outed herself to anyone before comes to you looking ‘like a man’, you’re going to have to potentially put away your ‘he’ and develop your ‘she’. You might get a genderqueer person who like me who uses ‘they’, or per, or xie, or one of the many other gender-neutral pronoun (or who, unlike me, doesn’t want a pronoun at all). If you’re going to be culturally competent working with especially the T of LGBT people, you need to know some people who are trans, have spoken to people who are trans, or have done some reading and training on the topic.

I’m sure that most people at the conference would have said that they were competent to work with LGBT people. Had I been a client, it could have done me a lot of harm. As it was, I’m used to it. It happens every day. It means that BAPCA was not a safe space for me, much like most other spaces are not safe. But for a client, it’s imperative that your space is safe. Ask yourself honestly – ‘could I consistently call someone ‘they’ without tripping?’ ‘could I call someone who would ordinarily be read as ‘a woman’ and who comes to my counselling room in a skirt ‘he’ without having an issue?’ Those are difficult things to do, because society genders us in to two groups. You’re stepping outside of it all to accept the client as they are, not as you want to see them.

The growth of my counselling service (creating your own placement)

I wanted to talk some about growing this counselling service. Except I’m not really sure how it happened. But what I do know is that I went from starting with one client a week in September 2013, and gradually moving up to two (My average was 1.5 clients a week for the first year), I was able to approach a counsellor I knew who also wanted to work in the areas of gender and sexual diversity and ask if she wanted to join me. I don’t actually know what her numbers were for that year, but I think from conversations, that they were much like mine. My supervisor spent much of my first year telling me that I should get a second placement, and eventually, in October of 2014, I moved my own placement down to one evening a week, and started working elsewhere one evening a week.

 

That seems to have mushroomed my service. From about November I’ve had an average of just under 4 clients a night here. My fellow counsellor averages about the same, and we have just taken on a new trainee who has started with two clients (and may move to more). From never having a waiting list, our waiting list hasn’t dropped under 5 in 6 months. I live in constant fear that it will.

 

Now we have left the umbrella of the service we were with and are applying to become our own charity. The paperwork is in, we have moved offices (to a much smaller room that feels much more cosy), and I feel like I’ve spent a LOT of money on chairs, room rent and electronic systems for us (some of these I have not yet spent – they are upcoming). There was clearly a need for this service in my local area given the wait – currently at four months, and the fact that in the last week I’ve had more than one person tell me they wish this service had been around for them when they needed it.

 

Not all institutions allow students to create placements. I’m lucky that mine did, otherwise I would probably not have been able to complete my course (I did not anticipate this complete lack of evening availability when I signed up), and I guess that this week what I’m saying is – if your course allows you to do it, and you have a specific area you want to work in that isn’t already covered locally, go for it! It helps if you have some marketing experience and the like, but my service has gone from non-existent to having seen well over 50 clients in two years (my numbers add up to just under 50 and I guess my co-counsellor’s will add up to less than that) and my average number of client sessions has gone up, from about 4, to about 10. I think that says something a) about my improving skills as a therapist and b) about the types of things that my clients feel able to bring. They certainly bring very different things now to what they were bringing a year ago. Maybe it’s just a standard thing – I don’t know yet, I’ve only been in practice two years. I saw my first client on the 24th Sep 2013, so just short of two years. And tonight, as my first night as ‘my own’ (there are four trustees; it is no longer ‘my’ counselling service, but it will always have been ‘my baby’) service in some way evokes all of that original process –How will it be? Will it work out?

 

I’m going with a ‘yes’!

Feeling the pressure of using ‘skills’

 

I remember how metaphorically naked I felt. That first session. My face (which has a tendency to betray me, colour-wise) feeling somewhat scarlet in a building not overly warm. I should probably go back and look at that blog post for the first hour – see what I said. But one of my biggest thoughts was that i HAD NO TOOLS! JUST ME! and those tools were a potential armour. The stereotypical ‘tell me how you feel’ not quite seeming to cut it as a protection in the same way that a CBT worksheet might.

 

It was just me.  Alone. With nothing. REALLY SCARY! However, I should say that my tenth hour was with a client who went on to stay with me for over a year. They recently came back to help them through an unexpected situation for a couple of sessions, and somehow the topic of them first coming, came up, and in the conversation I mentioned that it was fairly soon (although I didn’t say exactly when) into my seeing clients that they came. They were surprised, not having registered that i was SO new. All my clients know that I am a trainee, but no-one has ever questioned my statements so I have never had to say more than I am comfortable with. But it was lovely to hear that I had not been seen as ‘rubbish’, even though I had nothing to ‘hide behind’, as it were.

 

But recently I spoke to a new client about the possibility of doing some focusing, because that feels appropriate for what has come to therapy. I’ve had training, I’ve USED focusing, but I don’t use it as part of my therapy, so to speak. I do it separately, and don’t use much of it in sessions. The discussion of, and desire of the client to try focusing sent me rapidly scrambling for books (noticing that one has gone AWOL and i haven’t the slightest clue where it is!), ready for the most recent session. And before the session, desperately trying to remember ‘these things are important. DO THESE THINGS!’. As it happened, we didn’t do focusing, as it didn’t feel the right time.

 

It’s a marker of how far I’ve come, that I was absolutely happy with just seeing a client, vs lots of panic! It was the application of tools that made the difference to me and has gone from being a ‘good thing’ (to hide behind) to something additive to my normal therapy. It’s also a reminder to keep myself up with the things that are important to me. I love the PCA, but focusing also speaks to me. And life – that has a habit of getting in the way. Must make/take time.

words

 

 

I drive an unusual make of car. It’s becoming more popular, but as it’s not a western european make, it’s got a pronunciation no-one expects from the spelling. Randomly recently, a client, as part of a point she was making, asked me what car I drove and I told her the make. It took her a while to understand the car I meant because of the spelling/pronunciation issue. It was an odd moment where I wasn’t sure whether to be explicit about the car (spelling it) etc or just hope that she got it (which she did after a couple of tries). But it made me think about some other clients I’ve had in the past, and a similar issue I have as a patient at my GP. Being the lucky owner of a chronic condition, I take a medication daily. Without it, I wouldn’t be working, or doing much of anything. But again, it’s unusual in spelling (not anything out of the ordinary for mediations – they’re all pretty odd!). I always always struggle to order the repeat, because I and the receptionist do not pronounce the medication the same way. I have just discovered (through google) that actually, neither I, nor ANY of the receptionists I’ve spoken to, have ever got that pronunciation right. But in my case it’s a two minute phone call and I can go away again.

 

In the case of some clients they will talk about medication conditions, or medications, and their pronunciation of those will differ from mine significantly; sometimes it’s down to a regional accent, sometimes it’s down to a misunderstanding (theirs OR mine) about what the generally accepted pronunciation is, and sometimes there is more than one accepted pronunciation (potato/potato etc). But it’s hard. and that feels strange to say. It’s a word. But on the one hand, I feel like I am not being congruent if I pronounce it the client’s way, and on the other hand I worry about the possibly of looking like I’m passing judgement by saying it my way. Thus far I’ve mostly avoided this by not directly referring to the client’s word, but it does feel like that might have to change soon. Do I yet know what I’m going to do? no…

Messing up

 

 

We all mess up when we see clients. And to prove it, I’ve asked around a couple of trainee friends and acquaintances to share some of their experiences with you. I’m naming no names, and I’ve changed details if people are possibly identifiable, but you’ll see from the list that the mess ups go from ‘inconsequential’ to ‘something that was talked about in supervision’. Some of them are mine, some aren’t. I’m not sharing which are which. But this is for students not yet in (or just starting) training – we mess up! It’s usually not the end of all things!

 

1: when getting up to show out a client, I stood up and immediately fell over. My foot had gone to sleep and I hadn’t noticed.

 

2: I wore my top inside out for the whole evening, only noticing on my third client.

 

3: I once didn’t turn the handle to the waiting room properly and as a result, walked into the door, and then the waiting room with a very red face.

 

4: Checking my phone between clients I realised I’d not put it on silent. Lucky for me, no calls came in!

 

5: I got in to my client room to discover the clock had been taken away and I wasn’t wearing a watch. I managed to time it JUST right

 

6: On an evening placement, I became aware the cleaners were cleaning as I was seeing my client and I had forgotten to flip the ‘counselling’ sign to ‘in use’. I felt my heart pounding as I tried to decide what was best to do. It seems daft now.

 

7: I asked for some fairly low-key advice on a client thinking they had left, but they hadn’t. It wasn’t anything that broke confidentiality, but I feel mortified.

 

8: Seeing a client for their second session I went in whilst they were getting a hot drink and started to say hi but they ignored me. As they turned around I realised it was a friend of the client’s and the client was there waiting for me.

 

9: One of my clients always has squash. All the others have water (squash is an option if asked for but they are the only person to ask for it). Last week I was flustered with the client before and I forgot and put water out. I felt terrible when they asked why they had water.

 

10: My files are anonymised. I had two new clients lined up to start in two weeks. When I went in to start, I didn’t have a record of what their names were. Luckily for me, they were recorded on an old version of the spreadsheet for the placement. It took me about half an hour to find the names. (They both DNAed).

 

So there you go. Random things trainees have done and had it work out ok.

 

What things have readers done?

 

 

Endings

Someone asked me to write about endings, so here it is.

 

There are several types of endings I’ve been through since I started seeing clients:

 

The ones where clients stop coming without notice and don’t respond to any contact

The ones where clients call (or text) and tell you they aren’t coming

The ones where clients come and ‘out of the blue’ tell you in session that this is their last session

The ones where you and the client plan for an ending together.

 

Putting aside the ones where you don’t see a client to plan, this is how I have experienced endings in the past.

 

When a client reaches a point where either they express a desire to end (or spread out sessions), or I notice that they seem to be heading towards this, I tend to point out that something has changed, and ask them how they feel about lessening or ending sessions. I often find that clients are surprised when I suggest that they can move to fortnightly (and then monthly) sessions rather than just ‘leaving’ and so far, I haven’t had a client say they would rather just stop – there is a certain safety net in ending more slowly and seeing how it feels to extend time without seeing your counsellor. I recognise that not all placements allow this however (I believe that my formal placement – as opposed to my own service – runs in this manner, although I’ve never tested it).

 

In that last session, it can feel odd – what do you do? How do you keep it person centered?

 

For me, I let the client run the session where I can. If I am at one placement I have to go through some paperwork. I get that completed at the start of the session, and then I let it go pretty much as a normal session in all honesty. I might ask a client how they are feeling about ending and explore that with them, but it’s unlikely to be the first time it’s come up – I would probably feeling a bit remiss I’ve got to an end session with a client and HAVEN’T talked about endings.Once my clients understand what is available from me in future if needed I am happy for them to direct the session as normal. As however they want to have the session. Is there something specific? No. For me it’s about making sure the client is ok in the last 50 minutes. I’ve had clients come in their last hour who obviously didn’t feel they *needed* to come, but wanted to. I’ve had clients come and say ‘I haven’t mentioned this BIG thing before, but I just want someone to know it: (XYZ)’, and then once I’m told, I become almost the ‘holder’ of that thing, and they feel they have achieved what they need. In my own placement, I let clients know that if they want to come back, they just need to contact me and I will put them on the waiting list (or offer them a space if there is one), and in my other placement, I explain what the procedure is (there is a period of time clients must wait before they can go back on the waiting list, but in that time the associated helpline is accessible).

 

There’s no real ‘one way’ to do it, and it’s more about staying true to each of my client relationships, than any particular ‘person-centered’ process. Do what feels right 🙂