Learning Journal 14

The agenda. The clients will have one, or several. Its something we as practitioners will also all have, or several, and for me its about bringing it into awareness so that they don’t catch us out. The clients agenda may be out there from the off, or explicit but there may also be a shadow side to the reason they are there, a hidden agenda. This could also be hidden from them. The same applies to the counsellor. There agenda may also be out there and explicit, for example “I want to help people”, but what lies beneath this saintly façade? For me it’s very much about the boundaries we have also, as the relational framework in which we work will be governed by these and how they emerge from the core agendas we hold. If for example our boundaries become unclear or blurry, such as when we want to make a person feel better, help or heal, or just to not want to listen to a certain narrative or topic that the client wants to express, then whose agenda are we really meeting? What is in the client’s best interests? That’s when boundaries and agendas meet for me, when something like self-disclosure or over-identification could cross a boundary but for the cause of meeting the counsellors agenda. It is perhaps only through constant self-examination and reflection in supervision and journal writing that the apparentness of our agendas can come to the forefront. By talking through what is going on, having it reflected in counselling or therapy we ourselves engage in then we can shin e a torch on what is going on, with a view to knowing so it cannot catch us out.

I found the conversation that we had at the beginning of the day very affirming/interesting as my studies have taken me around the examination of altruism and giving to receive, but its not a view I share with everyone. For me there is absolutely no such thing. Maybe I found what I was looking for on this one as it supports my views on many things. But anyway to me the act of giving is an entirely selfish act, but not selfish in the horrible negative way, but one that has evolutionary purpose. We act for ourselves so that ourselves can survive, pass genes on, fit into society and make sure our family/similar people do ok. We are social creatures and for me that sense of contributing to others may secure us that help or reciprocation in the future. I give to you today, so you might be able to give to me tomorrow, when I might need it. I’m ok with that. It’s not a conscious thing when I donate to the soil association or the green party that it makes me feel good, but I know that I do. And that honesty is all about taking our acts of ‘generosity’ to a deeper level. For me that’s part of my agenda in helping others, that helper’s high to make me feel like I am doing something that makes me feel good is perfectly ok with me, and perfectly ok for others to want to do it too. It feels good. Its ok.

Skills practice was a neurotic nightmare for me this week. I was paired with the kind of person that I can on occasion have the propensity to lurch away from, like a magnetic opposite. The role I played was of a counsellor with an agenda. I took this to light-heartedly and the session began on the wrong foot. There is learning there for me, for sure. Its actually my most common mistake in many scenarios, not just skills practice, but skills practice is very much set up to fail for me, being when I am tired, over-fed and out of attention span. In it, I was opposite, in every sense, to a client who was barriered from the off, before I had any chance to play a role with my agenda. The client I felt decided to make it a game from her very first sentence, at least that’s how it felt to me, scuppered the session. So while I probably didn’t help the situation by being overly probing and clumsily looking for past issues that weren’t there, the fact is we are doing a skills practice and no-one in training benefits from such a difficult client. Its pointless.

In some sort of childish pointless comparison I know that in the previous role play I had played along with a counsellor opposite me that had been wholly inappropriate and terrible, deliberately, but to have been so awkward would have been pointless. I played along. Yet when I was the counsellor the client was not this forgiving. It left me feeling a little cheated. I found the experience of doing this week’s skills practice wholly unpleasant and annoying. Worse still I was barely able to be congruent with the client about how they were making me feel, which would have made it a positive learning experience for us both I suspect. I didn’t go into the skills practice aware of this so yet again I only have myself to blame for going in unprepared, but I suppose there is something in me that has expectations about skills practice. I do not feel it’s a time to be the most difficult client the world could throw at you. I just don’t. We’re trainees and ham acting to extremes is not making the best use of our time. For that reason I got annoyed with the person opposite from the very start of the role play as I felt it was just a waste of time.

I had supervision almost immediately after this day in college, which was actually very useful I think. As well as my caseload questions I brought the car crash role-play as it was on my mind. I restated exactly what I have above but instead of looking at the rights and wrongs and burdening pointless sense of injustice, the fact is I was unable to let the person know how I felt. I was not honest with the client that I felt annoyed. There are ways of being congruent with clients that are for their benefit and I think it’s a growth area for me to be more boundaried in this way. I need to be able to let people know exactly how I am feeling and what a wonderful and freeing place that would be. I think.

What then of my agenda going in to this exercise? Was it to have fun? If so that may be why it was so disappointing as it was the opposite. Why am I going into a skills practice looking to enjoy myself? Maybe the afternoon lull combined with a propensity to lack enjoyment in other areas of my life at the moment made me not take the activity seriously enough. Perhaps. Maybe it is to hide the fact that I am lacking confidence in front of others. As I was very aware I was being watched this time. I know that I am not at all like this with my clients at Chy. I actually feel like my placement is going incredibly well. I think the fact that I am so different in role-plays frustrates me somewhat as I know what I am like when with clients on placement.

Supervision this week

In supervision this week I brought a couple of my clients that are causing me to think ‘am I giving them the best service as a counsellor?’ I have two men, both called ‘S’ who are seeing me yet feel that they are ready to leave treatment and sit opposite me stating that they are ‘fine’ and ‘alright’. It then poses the question do I explore that given the reality of the fact that after decades of physical and mental abuse caused by substance addiction, it is likely that they are not ok and this causes in me some anxiety, which it is surely congruent to share, or go with it?

Should I let them use the session to talk about content rather than process or is that a waste of everybody’s time? I can’t say that I have reached a satisfactory conclusion on this question, whether someone’s best interests at heart are ok to follow. It feel uncomfortable that if I have anxieties to not be congruent to share that with the client if I am wanting to be honest and real. Yet are my anxieties for them borne of my own imagination of how much trouble they are in? Being person centred means to follow their own way, they can self-actualise, and the client knows best and deep down knows what is in their best interests. So for this reason I feel its always going to be something I have to raise in supervision for the time being.

I brought this up in supervision and it was very useful I feel. I felt quite validated that while I want to always maintain the focus on the client as this is ethically best practice, to work with their agenda, I also have to know my tendency to over-identify with clients with substance misuse issues and the historical fact that so may will relapse after leaving treatment. So for someone to tell me they are ok may not match what I am seeing, feeling or getting from the client. Then is it in their interests, not mine, to let them know my concerns, anxieties or sense of concern?

I think also that hearing back from another person in the role like I can do in supervision I can be reminded of the need to model behaviours and the greater role of the counsellor. So often it’s easy to get lost in focussing on minute bits of skills practice or for me to get sucked into thinking “wow, I’m actually doing this!” Very distracting thoughts can interfere with the actual practice and would be best left to reflection. Also I’m starting to really value the process of supervision as a second reflection, a supportive and less negatively critical process following the event.

learning journal 10

Safeguarding

So I thought this was going to be quite a boring one, safeguarding. How wrong I was. My previous experience of safeguarding training has been mixed with some great stuff by Devon and Torbay councils but not always the case with other providers. I guess the beauty of our training is that we get to discuss our opinions and feeling around issues and what this raises. However, this can also raise other issues to reflect on.

Today I became quite angry inside over an issue when the group was feeding back around how they would/wouldn’t have acted upon a case study example. For me it was quite black and white. The issue itself was over a suggested example of a 15 year old girl whom we could or could intervene in order to protect given what we are aware of, in this case a paedophile uncle actively attempting to re-engage with her. The discussion became quite heated when as I felt some members of the group had gone 100% person centred at the expense of the safety of an individual, and would not have acted in any way beyond supporting the person in the session to try to find her own best strategy.

While that is a laudable example of the purist person centred approach and one I would agree with on the whole, the age of the client, 15 and the potential harmful consequences immediately removed any shadow of doubt that I would have broken confidentiality with the person knowledge as her safety and well-being were my responsibility now as an aware citizen. That there can be any confusion in the case of a minor is worrying for me. Yes there is a process of evaluation so as not to act in haste, but we had had that as the counsellors to be had had a lengthy discussion about it. What followed was an alarming justification not to act as the client’s confidentiality took precedence. I saw quite a clear case to act given a school girl rape victim was currently threatened by the perpetrator and was in immediate and current risk of distress if not worse.

Looking within at how I felt around this was more interesting. I felt angry. It was a feeling borne of frustration I think. I know I was on a short fuse and have been for sometime with moving house stresses and getting ill so often lately which I think is due to lack of sleep. But, why am I frustrated with others in such an unproductive way. Frequently I don’t understand things the first time. This is happening a lot to me at work also over the last few days. I have been getting frustrated with people at work for not pulling their weight or doing things in what I feel is a wrong way, and this is not at all helpful to one of the biggest things you need in a workplace environment, to get along.

What I’ve noticed is that I am highly critical, of everyone, including myself, which is a character trait I could do without, quite frankly. Also this seems to be accompanied by an urge to be right, in discussions with co-workers. Its over-riding sometimes and takes over what I know to be better for me in the long run when for example I speak in a team meeting. Its not whether or not I am right that matters in the long run. People always come round to the better option but like in counselling, the better outcome I guess is for them to need to feel its their decision and I cant make it for them.

This is a factor in all my interactions particularly when I’m tired or under siege from feeling overwhelmed by tasks. Right now I feel this very much and wonder if doing the course was the right move this year. If I take this feeling of being overwhelmed in to my work place with clients then I will become less tolerant of them, irritable. I would lose the person centered approach and not be with them in their experience. Further in my role on Saturdays as a counsellor in training I would struggle to be present in the moment if I start to apply a judgementalness to my listening skills. This would totally detract from the experience of being there in their shoes for everything that they are saying. I recognise this in myself. So far I am confident I do keep it out of my one to one work with clients, but I have started to see it leak out in group work in my job role with particularly difficult boundary pushing behaviour working with addicts in the community.

An example would be yesterday in stage 1 drugs group, which is a group I co-run with another person. We had devised a group looking at self-awareness and denial, but during it clients began to get food out and roll cigarettes. When I asked them to stop doing this I noticed my reactions were short and irritated. In that moment my impatience and judgementalism came through and I could see it in the responses I got from some of the clients. The fact that I was less tolerant than usual over the boundary pushing and that it was apparent clearly could have a negative impact on my client work.

I recognise that stress is playing an important role in my ability to humanistic with clients, my ability to not be cynical and my overall feelings towards my client group on the whole of late. I am recognising after the event a lot of times yesterday that I was not tolerant of clients in their boundary pushing, which is only part of who they are in this process perhaps. I am quite shocked by even how a rise in stress levels has had abeit a small change in my reactions to clients. Partly I think that it is a rise in congruence when boundaries are being pushed which is no bad thing, and I feel that by and large that is the impact is has had on clients but also the emotional responses of anger behind my intolerance has been what I have been left contemplating. Clients will have noticed that shift. In one to one sessions client will notice that shift should it come about and then the impact would be really poor to the therapeutic alliance. All this leaves me feeling this week that I have been more emotional and I recognise the need for self-care. I look forward to therapy when it comes. I look forward to the house move being over in December also as this is probably the stressor that’s proving too much for me at the moment.

Gong back to my placement now I saw two clients this week in Truro. One was a man who presented with no issues at all. Quite an interesting session we had exploring positivity and moving forward. S was at first quite a tricky client in so much as he was seemingly quite reluctant. However I embraced this in a light-hearted way and worked more on building a connection between us so that he would feel comfortable in sharing. Sure enough this then brought out a lot of exploration in the past and present that I feel was an hour well spent.

The second person was completely the opposite, as they really wanted to unload. J presented overwhelming grief for recent losses of both parents and the upheaval that losing home, job and health in the past 18 months had made on her life. It crossed my mind that a counsellor in training may not be best suited to such an intense amount of emotion. However, I just stayed with the client, used all the basic listening and focussing skills and had no agenda to fix at all. I feel we accomplished a huge amount. It was emotional for the client and it was quite a draining experience being with such emotion for so long and I felt exhausted afterwards.

With both clients I clarified the level of confidentiality. I am really getting to grips with this as a fundamental aspect of introducing what it is we are able to do. It clearly sets the boundaries and truly informs the person what they can expect. I stated that what they discuss is confidential, although if they let me know that they will harm themselves or another or I believe them to be at risk of harm, I am duty bound to break that confidentiality. However, I will do this with their knowledge if at all possible. Also I was very clear about me keeping brief notes and relaying concerns to the team which I am part of. The other factor given that this is part of a service within a rehabilitation service for alcohol and drugs clients in recovery, is that I obviously make them aware of the provision to break confidentiality if they reveal that they plan to or have used mind altering substances. This is due to the risk they may pose themselves or the dangers that this could have on other vulnerable members of the houses. Some of this I read from a contract, but I always make it part of a wider discussion if the person intimates that they want further clarification. I feel that I am very comfortable with expanding on this and know the value of dealing with these issues right at the start of the relationship, as it makes that person feel boundaried and safe I feel, knowing what are the confidentiality limits.

I did speak to the engagement worker immediately after and only them, as it was necessary to hand over some of the essence of what had gone on, with a view to managing risk. The clients are bringing up very emotional things for them and leaving themselves vulnerable. This particular client group can use mind altering substances as a coping strategy for difficult emotions and so to let others in the team know that this has happened is really important.

I handed over to Sheeana the engagement worker for about ten minutes after the sessions. This was a very important part of sharing the process that the clients had been through so that we could ensure their care and safety, but also part of integrating the team as a wider and unified cohesive unit. It is really important for us all to feel that we are all aware of what is going on for the client group and that we are all aware of what is going on. This enables us to be more alert to risk, managing risk but also to build our working relationships to enable a strong bond between us as a team.

In line with the basic principles of the Data Protection Act 1998 (http://www.legislation.gov.uk/ukpga/1998/29/contents), the information I have is only to be used fairly and for limited specific purposes so that Sheeana and I share for a specific reason, the protection and support of our clients. We shared information in a specific and relevant way and in a safe and secure manner. In order for this to happen we shared client information behind a closed door in the team office so that clients could not hear us. Had there been any alarming risks or need to alert others, there is duty on call worker to bring in and we are very aware of how to do this should there be any need to involve them. This could be for very immediate risk of clients breaking rules in the house or for example clients’ fighting as happened on Monday just gone. At all times the mood in the house and the relationships between clients has to be monitored, after all these are people regaining emotions and living on top of each other in quite life changing circumstances. Had I felt that there were any such risks I would have called the on-call worker in addition to liaising with the engagement team. Further to all of this I wrote an anonymysed email to the team leader afterwards detailing who attended, any concerns or otherwise. This is a soft copy of my anonymous notes, which are very brief after each session and go in a folder, which is then locked away in the team leaders cabinet in a locked team office. This enables the team leader to check who is making use of the service and gaining from it, which in turn highlights risky attitudes possibly if they are not. Also it makes very clear any concerns or risks I feel that there are for the team leader to be aware of over the coming week, as he will be privy to their visits and general calendar events. Should these create any further raised levels we are sharing as a team to best prepare for the client to be supported.

Learning Journal 8

Confidentiality

I was unable to attend this week so made some readings of my own on the topic and also referenced my own personal experiences given that confidentiality is a massive part of working with clients in my particular field of alcohol and substance misuse work.

Essentially confidentiality is the rule or promise that certain information will be held with restricted or limited access. What this means is that we make it known to a client that what they share with us is treated with respect and privacy, although we elaborate on the lack of absolutes. In the counselling field the BACP explains respecting privacy and confidentiality more thoroughly as “a fundamental requirement of keeping trust and respecting a clients’ autonomy” (BACP Ethical Framework). What this means to me is that we as practitioners need to be clear with our clients about what confidentiality actually is, how we will ensure that we maintain it but also what the limits to that confidentiality are.

I am always open and clear about confidentiality in both my group and 1-1 settings with clients. Certainly when I first meet with them I am very thorough about what it means to have what they tell me treated confidentially. I am also very clear that I store records on a database and that I work in a team, which means others may have access to these notes. I justify this as being necessary for us to provide a thorough and professional service, as my team may need access to what has been discussed in my absence or days off. I get them to sign a form with any names or organisations or agencies they would be ok with us sharing information with, such as a relative, GP or social services for example. Usually this is only level 2 data that we will share unless the client specifies we can share further. Level 2 data being simply acknowledging that the person attends the service and also how frequently they attend/miss sessions and also some surface acknowledgement of how they have engaged.

By ensuring the client is aware of these boundaries to confidentiality we can make it known to them how safe their disclosures are. The client can then trust the process in so much as they can feel what they disclose can only travel within certain limits and wont be shared unnecessarily with other people or agencies. Even if this were to happen the client would know that they are made aware of this sharing of information wherever possible. This is how we treat people with respect and dignity, which is all part of delivering both a professional service. Also this professional service being ethically sound and respecting the client’s autonomy as we ensure that they are fully informed of the process, its limitations and how their disclosures will be treated.

For me its very important that I am clear with clients about the limits to confidentiality but also that we work in a confidential way. They must be informed and give their consent. It gives them a feeling that they can open up and trust us as a service. Without any confidentiality how could they being to do any work or disclose anything at all? This all comes from being very clear about the boundaries to confidentiality in my opening contracting with clients when I do their full assessment after they have been allocated to me as a recovery worker. Additionally I get clients to sign a confidentiality waver so that we can with their consent contact the GP, store data and disclose certain information to others that they have specified. If I am open and clear about things like expectations of engagement or confidentiality and its boundaries at the outset, it means they client is given respect and autonomy and is informed to choose whether this is the service for them.

If ever I needed to break confidentiality I would seek the supervision of my line manager whenever possible. I would also involve the client whenever possible. It would really depend on the reasons for breaking confidentiality and what has been disclosed but essentiality my concerns would be around learning that any individual was at preventable risk of harm, or that a serious crime was or had taken place.

Last week a client’s brother called the service wanting to speak to me and encourage me to call the client. I could hear his desperation and that he had real concerns. I did my best to be polite and explain very clearly that I was unable to disclose client’s engagement in a respectful manner. I could also tell that this caller was likely to be legitimate and was very probably a concerned family member, however I did not have signed consent to speak to him about the client. What I did was suggest that he ask the client to call me and at least pass on verbal consent to speak to this person. While not ideal it would give me chance to confirm verbally in the mean time that should I receive a call from this individual I could at least acknowledge the client was known to us as a service.

This was a potential incident that was avoided by not disclosing. However on the other hand, had I gotten consent from the client before hand to speak to the family member, I would have been able to confirm the client was engaging with our service and that he was attending appointments, which may have left them feeling less anxious. Concerned relatives frequently call our service.

What this episode confirms to the client is that he can talk safely and openly with our service. We do not disclose information to third parties in these sorts of circumstances and that we treat his engagement in our service with respect. It left me feeling reassured despite the pull of a concerned brother being on the line at one point. No matter how much they want to know their brother is alive or trying to beat heroin, its not ok to share that information without the client’s consent. On this occasion I didn’t feel it presented an ethical dilemma as while I did have some feelings of wanting to help the distressed family member on the phone, this was overridden by my knowing the boundaries to confidentiality and why they are in place. At no point was I close to breaking the clients trust in us as a service.

Learning Journal 4

Diversity has a lot to do with empathy I believe. That is, the ability to really understand how it feels to walk in that persons shoes. That alone takes a real letting go of preconceptions, leaving thoughts at the door and being prepared to open a new page on whatever that person brings. They are not a book you have already read. For me it means being prepared to work on my tendency to feel like I already understand someone, rather than maintain the desire to keep trying to hear how they experience their world and not adjust it to my own objective realities. When it comes to how that person has experienced their own challenges by way of prejudice or inequality, it must be incredibly important to believe that persons recount of their experiences of diversity.

Crucially to the client that shared experience of their understanding of how they have been stereotyped or discriminated against can only come if we as workers allow ourselves to do 2 things. Both to truly experience their reality but then to convey our understanding of that reality also. Then the counselor will be able to know how that person experiences their uniqueness or sub culture/micro-culture, but in a therapeutic offer, be able to share that understanding with the other person. That would then be a communication between the two people that may form a connection and so be supportive and beneficial to the client.

Diversity is going to work on so many different levels in counseling as the therapist surely benefits from being both aware of the 100% individuality of their client, that the client may or may not know their own uniqueness within their world and also that the therapist needs to aware of their own biases and prejudices and self-held beliefs that may impact the work they can offer a client. By communicating a shared understanding of the clients individual experiences to the client from the therapist by being known, the client can have their experience validated and whatever issues they have brought they can now look upon with a degree of validation and greater self-interest.

To raise self-interest and greater self-respect is key to a lot of my current in the drug and alcohol field. Although I do not counsel clients I still support them and play I feel a potentially important role in facilitating them to access their own resources for positive change. That requires the core conditions for me and pertinently, an appreciation of their experience of diversity issues given them often come with marginalizing compounding issues beyond the drug/alcohol ones, often being the pre-cursor.

I experience a strange reaction to clients in the drug and alcohol field, that I meet sometimes that I can only describe as empathy then a building prejudice. It really is rather strange. A very recent and very illustrative example would be this week. I interviewed a client transferring from Plymouth to our region and who wanted prescribing methadone. I spent about 40 minutes being right there with him in his anxiety, difficulty to attend groups, inability to use public transport, in and out of prisons, struggle to feed 4 kids, no job, partner caring fro him as too anxious to leave house on his own. Then his exacerbation at the cost of getting to our service meant effectively he had to pay for his methadone. It was that last statement that all of a sudden bothered me. “I have to pay for my methadone” – by proxy as we do not refund public transport. Right then and there he lost me. It really bothered me that he had so much for free, then had the check to complain he may be inconvenienced to access his free class A drugs. This is big for me. It goes to my very core. I think I want a society that is supportive and inclusive and doesn’t let anyone fall through the net as it were, but at the same time I cant stand laziness, something for nothing culture and expectations of others to provide when you yourself offer society nothing. Where does that come from? Is there a something for nothing culture? If by developing a feeling of entitlement would I not simply be enabled by a lack of support and inadequate life chances?

Its only when feelings like this really jar with me that I can notice my attitudes and prejudices. Where do they come from? Maybe my parents drumming into me the contempt for laziness from an early age or the culture of working as many hours as possible to be ‘successful’. Possibly a search for validation from others that may come from being a member of a team/society and precisely not the member of a team/society that needs to be carried. I am not sure, but I do know how it feels to be carried. The trap that it is, the cycle of being tied to a ball and chain that is a dependency and with it the inability to value yourself, to be physically or mentally able to set goals let alone achieve them. Couple with that the lowered self-esteem that comes with attending services, having to claim benefits and not being able to hold down a job. Yet, even having been there in my own position of feeling trapped, I still have to actively challenge the negative feelings that can be raised in me when it comes to hearing stories about people in this situation. Are they products of environments? Was I? Do I not still feel that ultimately I had choices, no matter how limited? Therefore can I blame myself for making poor choices, still? Do I still blame myself for making poor choices and carry a burden of this blame? If this is the case, how much are these ideals still going to be present when I work with a client base that largely is dependent and may well have made poor choices? Can I realistically maintain the conflict? Its interesting that when I am working with people on a one to one basis, this has never before cropped up, only when that one comment was made and pushed buttons. All times previous I have not struggled with core conditions but I recognize in me when that service and role comes under threat.

It actually feels quite a lot of relief has passed over me by getting this on paper. By expelling these thoughts I feel lighter. By going through this process I can be aware and know that this could come up for me with clients and to be mindful of it and how I express myself in these situations, but also that I need to be aware of my buttons and what pushes them, then I can be a lighter and less burdened practioner.

Over-identification is definitely something I need to be mindful of as a worker with clients who present with drug and alcohol issues. The marginalization, the prejudices and the stigma attached can feel all too familiar, yet is it? Is it familiar to me at all? My family were particularly exhausted and frustrated but my years of addiction, yet that does not mean I can relate to another persons family problems or the lack of work, or the being in a bed-sit. I can recall multiple issues being in a fog of chemical dependence yet it doesn’t endow me with insight in to another’s world. Not one bit. Not if I to offer them true empathy.