Learning Journal 24

This week we looked at self-care and fitness to practice. This is a very pertinent session for me as I am starting to feel burnt out in my job for various reasons, mainly because I feel overworked and undervalued.

This week I saw 2 clients at Chy. Both brand new to me so I was able to go through my contracting and confidentiality explanation and explore with them what they wanted from counselling.

First I saw client M. From memory I said something like “This is a 50 minute session I explained and we’ll meet as often as once a week. You will need to book the sessions via Martin the team leader and my line manager. What you say here is confidential, however I do work as part of a team and I do feedback if I have any concerns with other people that are part of that team as this service has your welfare and also the welfare of other people to consider, does that feel ok? I store some brief notes in a locked room, Martins room and if you tell me you are going to harm yourself or another I will be duty bound to share that with others so as to manage that risk. Does that sound ok?”

To me this was enough detail without overwhelming clients. I know that I have quite a short span if I cant rehearse information that’s coming in or process it, so maybe that is my worries a little but I go the sense from M that this was enough information. What I also felt though was that I needed to explain a little more clearly how I sometimes need to share concerns with the other members of the team, and that could be a support worker on site or to make Martin or the on call counsellor aware. I do speak to Greg the most commonly available support worker after I have seen clients, as I want him to just be aware of any issues that may or may not involve the safety of the house as a whole. We do this behind closed doors and with no one else able to hear. This is to maintain discretion and confidentiality. I also always store my notes in Martins office in his cabinet, and the office has a key code entry. My notes are always anonymous too.

I introduced the fact that I work within an ethical framework, that of the BACP. I don’t think that M was terribly interested as he clearly wanted to ‘get going’ as the session later showed, but it is good practice for me to do this. I want to be able to work professionally and be respected for my work, but also I will be happiest if clients trust me, feel confident with me and I feel that explaining all this goes a long way to them feeling safer and potentially ‘held’. I stated that I work with an ethical framework and that meant that I am supported by a professional body called the BACP, who provide a set of values and attitudes that I aspire to and work by. These values and attitudes are for me to work by and they are to protect the clients because they are about good practice. I explained they are guidance for me and all counsellors who are part of the BACP to aim to be working to these standards of practice. They are always there for me to look over and keep reminding me of what it is I need to be doing. Things like doing no harm, looking after myself and not working when I’m not fit to do so and also that there is a place for him to go to if there is a need for him to complain and its in a publication for all to see. The BACP is also a place clients can go to complain about my practice although I explained that he may wish to first go to my line manager, Martin Bennett should he feel that I have done something that has made him feel uncomfortable or like it shouldn’t be that way. I showed M a copy of the guidelines as I carry them around in my folder for this role, more as a prop than anything else but it is reassuring to me to have them there, plus it looks well prepared and the client is welcome to a copy. I used a quick example that the guidelines ensure that I am present and with the client and by that I am not under the influence of drugs or alcohol, I am not overtired or not in a fit state to be there. Also I told M about my supervision and that it is regular and in it I discuss my practice to make sure that I am doing a best job as I am capable, in order to put the clients first. M did seem a little bit interested about this, that I had a kind of counselling. I just elaborated that in it I talk about how I felt, what I did and it was all about making sure what I do is in the clients best interests at heart. By introducing this concept to M, I have ensured that he is aware of the governing body so to speak and that he has a place to go to enquire about my practice or what lies behind it. I also felt that it gives the client some sense of the seriousness and professional attitude that I am taking over his welfare and these sessions.

What I always do is alert Martin the team leader verbally if he is available or by email as to what has gone on in terms of themes and process so that we can work together to support the clients in a wrap around care manner. This is to also inform him that I have seen certain clients so is aware of their support package being met and also I will alert him to what has gone on with regard to any concerns. As I use gmail which is not a secure network I only use initials to keep it anonymous. I will alert him to a client who is experiencing severe mental health issues perhaps or if they are aware of rules being broken in the house. However this week I simply gave a very brief overview of the level of engagement from both clients, the themes and that I felt that he had nothing to respond to in terms of elevated risk.

I have supervision next week and I really want to start to explore things in my practice even further, especially as I have had quite a break from it given my break from seeing clients over Christmas and holiday. The thinking and planning I’m doing after the session has really begun so that I can bring what actually matters to supervision now that we have developed a good relationship. After my session with the second client, T, I have been left contemplating the level of disclosure which I want to explore in supervision. Also my approach to different clients I will bring my disclosures to explore what they meant for me, the reaction it brought in the client and to learn about who’s stuff was out there in the therapy session. I will bring how I enjoyed one client more than the other, as I favoured the time with T more than M. That’s only natural I suppose but does it impact the clients? Does it mean that I act in a different way or am more likely to give away micro gestures that show this to the client, because all people notice things like that I think. Why I will look forward to one of the clients much more than the other? That I still enjoyed and found a connection with both but

I was also left thinking after the two sessions that I felt quite differently towards each client and what they had brought. One client, M had wanted to stay in content, which felt ok for the first session. The second client, T, had wanted to try to immerse himself in the analysis. He had previously studied counselling at a level 2 and strangely I found that both helpful but a little pressurised. I felt that I was slightly challenged by his overall approach. It was not I am quite sure a deliberate confrontational stance, but T was a lot more intellectual and so I was slightly wrong footed I guess. The professional client phrase springs to mind. How do I handle someone who is more aware of the process and the route. Are they aware or should I just go with whatever they bring anyway? Did I actually enjoy this anyway, or was it just more stimulating? Should it be more stimulating as I should be giving every client 100%. I will bring all this to the supervision session.

I have got a specific book that I use to make notes for my own feelings and supervision notes. This I bring to supervision sessions. My supervisor did advise me to start reading Yalom, which I have as I now have Yalom’s “the gift of therapy” which I dip in and out of. What I have begun to learn about from this book and supervision is the use of my own feelings in the session as information to go on, and what I mean by that is to notice how I am feeling in a session and think about whether it is something that other people in the clients world may be experiencing too. This can help me to understand the clients world. Is the person overly negative, critical and how does this make me feel? All this is really relevant data to be used with helping me to empathise with their world. Its not about needing to feedback to them necessarily but it is about needing to be compassionate and present.