1. Thoughts From The Couch – Loving our imperfect body

    August 19, 2020 by Juliette Clancy Juliette Clancy

    For many people, their relationship with their body is the cause of much unhappiness. Is it any wonder when we live in a society that steadily and unfairly suggests we should be changing it in one way or another? Chronic body dissatisfaction is an epidemic with negative body image issues impacting both men and women who believe that there is something ‘wrong’ with their bodies. There are four aspects of body image: Perceptual, affective, cognitive and behavioural. How we see ourselves, the way we feel about the way we look, the thoughts and beliefs, we feel about our body and the things we do in relation to the way we look.

    I have worked with many clients who despite varying forms of camouflage, feel intense dismay with their physical appearance. To a greater or lesser extent, they are fixated on what they do not like about their body with the sincere desire to alter or hide it. They feel acutely self-conscious and ashamed comparing themselves to others along with the standards that have been shaped by rampant social and cultural ideals. As a consequence, they live with eating disorders, various forms of self-harm, isolation and mental illnesses all driven by the lottery we have all been made to play without ever being asked. For most of us, there is a relatively good correlation between what we think we look like and how we appear to other people, but for others, it is as if there are two different people – the one we see and the one they see when they look in the mirror.

    For some people, their appearance becomes the single most crucial aspect in defining them as individuals, and they hold attitudes such as ‘I am my nose’. For my client who was fixated on his nose, his whole life was impacted by how he saw and imagined others saw his nose. From my perspective, there was not anything out of the ordinary about his nose, and yet it prevented him from entering into relationships, making friendships or doing many other things. Each day he battled the crippling shame of his physical appearance that deprived him of achieving his deepest longing – to have an intimate relationship and family.

    When feelings of being self-conscious or ashamed become out of control, it often leads to body dysmorphic disorder. This does not mean being vain or self-obsessed. It is a profoundly distressing and life-limiting experience whereby we cannot stop thinking about one or more defects or flaws in our appearance that often cannot be seen by others. We become so obsessive in our belief that some aspect of our body or appearance is seriously flawed that we go exceptional measures to hide or fix it. Clients of mine are so embarrassed, ashamed and anxious about their physical appearance that they find themselves avoiding social situations, friendships and intimate relationships with the impact being devastating to their lives. For some looking in the mirror is so traumatic that their only option is to cover any mirrors that are in their home.

    We are not born hating our bodies, and yet we live in a culture that teaches us to do so. Society sends us messages about how we are supposed to look, and as a result, we attach our worth to the size of our body and physical appearance. Young children with access to the internet and social media live in a culture in which peers and the media broadcast the thin and beautiful ideal in a way that negatively impacts how they view their developing bodies and as a result their self-assurance. Suddenly their childlike inhibition is replaced by a cycle of self-shaming thoughts and behaviours. They become preoccupied with comparing themselves to others. Once thoughts have been held long enough and repeated enough times, they become beliefs, eventually, the beliefs become biology. By trying to change themselves to be like others, it starts them on the path of dishonouring their authentic self, allowing how they feel about their bodies to influence how freely they can inhabit it.

    Many parents are not aware of how their low self-esteem can be passed on to their children. With the hatred of our bodies profoundly, negative messages about them are passed on unconsciously from generation to generation. Many of us were bought up with caregivers who made negative comments about their bodies. Consequently, in addition to societal messages, what we witness at home dramatically shapes how we see ourselves. We see food being restricted, excessive exercise and endless adverse messages that make us start to examine our own bodies in mostly negative ways. As a result, the attitude that our bodies are in some ways ‘wrong’ gets internalised, often at a very young age, and sets the stage for our future relationship with our body. We unconsciously start our journey of self-loathing as we stare at ourselves in the mirror as part of an ingrained ritual of self-hatred. As we undress for bed, we look in the mirror and zoom in on parts of our body that we dislike the most – the parts we want to change and wish were different, and the descent into self-loathing and shame continues. For some, their friendships are bonded over their shared body dissatisfaction sharing diet tips, and details of surgeons that they hope will ‘fix’ their body, and then their living can begin.

    The constant repetition of negative thoughts about our appearance infiltrates how we act and behave. By the time some of my clients come to see me, they are living with the consequences of a life based on how they think they look. For others, they come as a result of an accident or illness that has changed their body image suddenly. I am reminded of a young man who contacted me by telephone as he did not want me to see him as he told me that he had been diagnosed with testicular cancer while at school. He had been too embarrassed to say anything about the changes that were taking place in his body that by the time he went to the doctor, he had to have one of his testis removed. He was so deeply ashamed that it was preventing him from entering into any form of intimate relationship for fear that it would be noticed. Whether the change is permanent or temporary, the impact of an illness or accident will be different on everybody. It can affect all aspects of their lives, including sexuality and intimacy. Body image changes as we get older and in a society that seems to revere the young that can be very difficult for clients who somehow feel unattractive and invisible due to the natural process ageing. Whichever category clients fall into, body changes can be very disconcerting. It can take a fair amount of time before they ‘see themselves’ once more when they look in the mirror. Supporting my clients through both physical and psychological changes such as fear, anger, hopelessness, and sadness is a way of normalising their concerns, thus reducing shame and stigma.

    That we have the potential to modify our destructive and unconscious patterns is a truth I see proven in my practice often. Change is possible and self-love should be too, and yet it is not as easy as it sounds. It requires great courage and self-belief not to get swept up in ways of being that unless consciously fought against seem to infiltrate our psyche without us even noticing. A first step towards making a positive change in our lives is to acknowledge that we are co-operating daily with a system that is making us deeply unhappy. Much like someone living in an abusive relationship who finally leaves because one day they realise that if they stay their life will never improve, each of us must recognise when and where we are co-operating with our own persecution.

    I have done all sorts of work with clients on their body issues. Depending on what they are coming with, I have used drawing as one way for them to compare how they see their body in relation to how I do. So often being visually confronted by the difference in perception of body shape and size is enlightening. One client spoke of ‘one of the most memorable exercises we did was you getting me to draw how I saw my body. When we went through the drawing together, I could see that it was not a real representation of how I looked. I had drawn myself as if I was an alien being, and it was a profound moment, recognising that the image that I was looking at on paper was the image I had in my head and yet not the reality at all.’

    Chair work is always a useful way of exposing our critical inner voice and the messages we give ourselves about our appearance. It can also help us make connections to where this voice may originally have come from. Like the client who always wore shoes that were too small from him remembering the voice of his mother who bought him ill-fitting shoes so that he did not have ‘monstrous feet.’ Another client remembered ‘you speaking about us all having both positive and negative voices in our heads, and it had never occurred to me. You spoke about how the negative voices will probably remain as part of us, but we have a choice as to whether we continue to feed the negative or feed the positive. I saw how out of balance the voices I had in my head were and have since made a conscious effort to be mindful of when I am being negative towards myself and balance it with the positive. My positive voice makes me feel so comforted that I can manage the moments where I find myself inadvertently being critical of my body. I carry you with me every day hearing your voice telling me to be kind to myself.’

    With other clients, they have asked me to take photographs of them so that they can see what they look like at different angles and in different moments as they have lost sight of what they really look like. I have worked with women who have felt so ashamed of their bodies that they have attempted to cover them up in varying ways. The look of pride on the face of a client I had been working with for several years, when she turned up in a dress. Prior to that she had lived in fear of other people’s judgements and comments about her ‘too thin’ body. As a way of protecting herself, she used to wear extra layers of clothing, always with a coat, ‘to make myself look bigger’ no matter how hot it was outside. The first time a client who thought her ‘legs were too thin and hairy’ wore a skirt moving through the belief that people would notice and be ‘repulsed’ by her. The tender moments where I have stood with a client as they have revealed a part of themselves that has been left disfigured through illness or surgery or birth disfigurement. Standing firm in awe and tenderness as they moved through the fear of exposing their vulnerability and shame.

    Being wholly and genuinely human means standing securely in the knowledge that our physical appearance is only a part of who we are. In accepting that we are imperfect, we can turn our attention to shining warmth and kindness into our dark tender place of self doubt, replacing it with appreciation, acceptance and love.

  2. Thoughts From The Couch – The individual journey of grief

    August 13, 2020 by Juliette Clancy Juliette Clancy

    This thing that we call grief that connects us all is one of the most talked about topics in my therapy room. Grief can refer to any form of loss as a person may grieve the loss of a loved one, a limb, a home, a sense of self and much else. ‘We are all in grief. All have experienced loss. Even if your loved ones are still alive, there is a place within of disappointment and loss because we live in a world where everything changes’ (Levine: 97).

    For this piece, I am going to use the word grief to indicate the experience of losing a loved one to death. Something that all of us as human beings will face at some stage in our lives and, as a result, something that unites us all. It is useful to bear in mind that there are many types of death: accidental death, suicide and violent death, to name a few. There are also many different stages of life at which people die, as well as experience the grief of death. Different kinds of relationships, backgrounds, original attachment patterns and divergent circumstances inevitably shape and influence the meaning of each loss, and all these ramifications present endless implications to me as a therapist. 

    People have been grieving for thousands of years – long before the advent of health professionals. It is a natural process, and yet the empirical reality is that many people seek help with their grieving process in the form of therapy and bereavement support. This may be in part because of the increasing secularisation of our age and consequently, the general loss of shared ritual and periods of collective mourning. For example, the Shiva house of the Jews, the Irish wake and the Hindu Sredu, are important but are declining publicly sanctioned opportunities for the grieving and their wider community to come together. So whereas previously, people would have been consoled by a collective belief in God and an afterlife, looking first to priests and religious institutions for comfort in their grief, now, perhaps because so many no longer adhere to such formal religious beliefs, they are more included to turn to their family doctor or therapy.

    In addition, the excessive mobility and increasing speed of our modern society further lends itself to this change of focus. In the past, extended families and communities were in closer proximity than today and neighbourhoods provided cohesive support systems in which people were more available to help each other cope with loss. It seems that in contemporary Britain, there is an almost complete absence of any established ritual and guidance around death and bereavement. In a mass society that appears to prioritise consumerism, youth and technology, engagement with death is often avoided perhaps because it implies a failure to heal, cure or solve.

    In modern Western society a more restrained attitude and the subduing of the natural expressive sounds of grief such as wailing and keening contrasts strongly with African and Arabic nations which embrace public displays of grief and allow their emotions to be visible and heard, helping the mourner to express themselves within a shared, public space. In addition, many spiritual traditions recognise a particular time period, such as a certain number of weeks as a timeline for bereavement, thus acknowledging, allowing and respecting the need to mourn. All this seems to be lacking in our culture where, mostly, mourners do not manifest their pain outwardly or even follow a specific dress code. Instead, the bereaved are expected to work through it themselves, as if mourning were solely a private process.

    Regardless of our personal views on grief, what is clear is that mourning often involves a culturally appropriate process to help people cope with their grief. While many cultures mourn differently, the process usually serves a common purpose: acknowledging and accepting death, saying goodbye, grieving for a specific time period and some means of continuing to honour the deceased. Ultimately the mourners are encouraged to move through their loss and form new attachments. ‘Grief is really a social process and is best dealt with in a social setting in which people can support and reinforce each other in their reactions to their loss’ (Worden: 87). Bearing this in mind I question whether we in the Western World are partly responsible for creating the need for bereavement counselling as what appears to be a natural community support in other cultures seems very different here.

    Grief reactions can have physical, emotional, cognitive, behavioural, sexual and spiritual components, varying in length and disruptiveness. ‘Grief, writes Parkes, ‘is a process and not a state’ (1998: 7). For some people, their attitude to death, funerals and the immediate aftermath seems to be a social embarrassment, almost as if death is a taboo subject. For others, it seems as if they believe that there is a time limit for grief, after which it should simply be ‘got over.’ This makes it difficult for the clients of mine who struggle to ‘fill the void’ that people talk about after someone’s death. For them, they feel rushed and well as ashamed to be ‘still grieving’ and concerned that they will ‘never stop grieving’ and the judgements they will face from others. The language of ‘closure’ is often used, implying that there is an end point to which we need to get to. It also assumes that people want closure, that there is a ‘right’ way of getting there and that people even understand what it means.

    You cannot rush grief. It is not a linear process and it takes huge courage to open the door to it once it knocks. The challenge that I face each time I meet a bereaved client is to find a way forward together, bearing in mind that an individual’s grief is as unique as their fingerprint. This involves listening intently to their story, acknowledging their feelings and guiding them towards a new, different and meaningful life without the deceased. It does not necessarily mean filling any ‘void’ or ‘closing’ anything. What we are working towards is how they want to adjust to a new reality and integrate the missing person into that reality.

    Bonhoeffer, who was a Lutheran theologian who lost many friends and family members in World War 11 wrote :

    Nothing can make up for the absence of someone whom we love, and it would be wrong to try and find a substitute; we must simply hold out and see it through. That sounds very hard at first, but at the same time, it is a great consolation, for the gap, as long as it remains unfilled, preserves the bonds between us. It is nonsense to say that God fills the gap; God doesn’t fill it, but on the contrary, keeps it empty and so helps us to keep alive our former communion with each other, even at the cost of pain.

    Although there is nothing fundamentally different in working with the bereaved than with any other client group, it is worth considering that grief presents an extra dimension for both clients and me facing existential concerns and unresolved losses of our own. Therefore I believe it to be imperative that I have addressed and, when necessary, continue to address my fears and beliefs around both my own inevitable death and those closest to me. There are few things of which we can be absolutely certain, but death, our own and that of others we care about, is one of them. ‘Each person must make his way through life encompassing two important facts. If he loves, there will be great reward of human intimacy, in its broadest sense; and yet when he does so, he becomes vulnerable to the exquisite agony of loss. And one day – he knows not when or how – he will die’ (O’Connor: 107).

    I have come to know that everyone grieves differently, at different times, in different ways, and with different intensities and as a result, I remind myself always to remain open to working with what each individual presents in the here and now. Grieving is one of the hardest and most painful experiences a human can endure. I firmly believe that by finding the courage to work through it, in our own way and in our own time – we can appreciate life with a renewed passion and can engage in choices and changes with a more profound sense of personal meaning and a greater understanding of ourselves and others – which can only be a good thing.

    Levine S (1998) Who Dies. Wheaton; Exeter, GB

    O’Connor R (1997) Undoing Depression. Little, Brown and Company; New York

    Worden W (1983) Grief Counselling and Grief Therapy. Tavistock; London

  3. Thoughts From The Couch – ‘Love’ in the therapy room

    August 10, 2020 by Juliette Clancy Juliette Clancy

    The susceptibility to develop intense feelings for your therapist has been known and talked about since the early days of psychoanalysis. It is often the theme of jokes and curiosity from others when I mention that I am a therapist. Yet for the client who experiences erotic transference, it can be a profoundly confusing, distressing and shameful experience, with nothing the slightest bit amusing about it.

    Is it any wonder that on occasions our clients fall in ‘love’ with us, or at least think that they have? The setting we work from sets the tone for a calm and comfortable environment where our clients are the focus of our attention for the duration of the session. We meet them with intense curiosity and prolonged eye contact, along with unconditional positive regard. We are rarely critical, pre-occupied, snappy or disinterested. Instead, we present with our full presence, empathy, curiosity, patience and a willingness to stay attendant to them no matter what they share. 

    Which of us does not yearn to be met in this way by our intimate partner, family and friends? The reality is that life is full of distractions and limited time and so the therapeutic relationship is ripe for erotic transference, which if not handled with care, has the potential to cause considerable disruption to clients personally and in their social and family life. Storr states ‘In the practice of his art, the therapist must treat those patients who make declarations of love with tenderness and understanding. It is important to realise that the love that is shown by the patient for the therapist is just as ‘genuine’, even though it may not be as realistic as love occurring outside the therapeutic situation.’ (Storr, 1979: 78)

    Transference whereby clients transfer feelings for a significant person, often parents, onto their therapist, is part of the therapeutic relationship. The transference, whether affectionate or contentious, is often unconscious and necessary to inquire into as part of the therapy. Erotic transference is a term used to describe the feelings of love, as well as the fantasies of a sexual or amorous nature, that a client experiences about their therapist. This needs to be handled with the same respect and interest as anything else a client might bring to therapy. 

    I see part of my role as a therapist to find a way to create an atmosphere of openness and safety, where topics such as attraction and sex can be freely explored, especially as for so many people talking about sex openly is often associated with shame and insecurity. By being both transparent and thoughtful, working through erotic transference can often help clients understand problems that initially brought them to therapy.

    It is imperative not to ignore transference as it emerges, which can on occasions be problematic, especially if the feelings transferred are those of love, idealisation or eroticism. Freud was clear-cut in his advice for handling romantic love in therapy, stating that the therapist must neither respond nor dismiss the client’s love. Instead, we need to regard a client’s love with the same composure brought to bear on their other feelings. To remain interested, curious and engaged without becoming personally invested. 

    We need to acknowledge that as humans, we are all vulnerable to moments where – when faced with erotic transference – we can respond in unhelpful ways. Sometimes where we find ourselves in our own lives can tip the balance in how we react to a client’s attraction to us. On one side, we run the risk of becoming the seductive therapist, using our clients as a source of comfort and validation. On the other side, we can become the punishing therapist, feeling annoyed or ashamed that the situation has arisen. As a result, we quickly close down the topic, thus replaying what potentially happens to clients outside of the therapy room. As a result, we deny them the potential to gain a greater understanding of themselves and the cause of their feelings. 

    In those moments, I am grateful for my internal supervisor to keep me on track. Instead of either fanning the flames of love, or making my client feel ashamed in having expressed their feelings for me, I can sit confidently in the middle. I can validate their feelings while letting them know that what they are experiencing is not only a normal part of the therapeutic relationship, but a vital part of our work together.

    Sitting in the face of erotic transference, we can find our powers of restraint pushed to the limit. Each of us has known the intensity of feelings we can have for another person and the challenge when we realise that there is no possibility of anything developing in the way that we had hoped. Accommodating these feelings from our clients, especially at their most insistent, needs to happen if the therapeutic relationship is to survive. A robust framework on which I can rely is imperative.

    The intimacy that I experience in the therapy room is different from the intimacy that I experience in the outside world. As a starting point, my client and I co-create ground rules and boundaries that I do not set outside of a therapeutic relationship. When erotic transference emerges, it is easy to feel in some way incompetent and vulnerable to the potential misunderstandings and upset that can occur, especially if the transference becomes obsessive and compulsive. Transference of this kind can influence a person’s judgement and interfere with their self-government, which in turn can leave them vulnerable to sexual, emotional and financial misconduct. 

    Working within a clear ethical framework is useful, especially when working with erotic transference, as most bodies state clearly that no therapist should have a sexual relationship with or behave sexually, towards their clients. It is well documented that the impact of a sexual relationship between therapist and client is nearly always confusing and negative, even if the therapy has ended. “Research shows that a sexual relationship between client and therapist is almost always traumatising and abusive in the long run, even if the relationship starts after counselling has ended.” (Joyce & Sills, 2001: 148). Despite this, clients in the throes of erotic transference can be tenacious in their belief that a sexual relationship would and could be possible, even if they are already in one outside of therapy. This can put an enormous strain on the therapeutic relationship, especially if there is counter erotic transference.

    Erotic counter transference is a normal part of working as a therapist, however similarly to my clients, it is not always easy to manage. In order to be congruent, it is important for me to take my feelings and any concerns I might have to my supervisor. This in turn shows my willingness to do what I am  asking my clients to do by being willing to bring out into the open and explore any erotic feelings I might have towards my clients. 

    Sometimes when faced with a direct question such as “do you find me attractive?” or “if I finish therapy with you can we have a relationship?” it is easy to feel put on the spot and pressured to answer. As I have gained more experience and confidence over the years, I can gauge whether to explore the reasoning behind the question or reply directly. Depending on my client, the strength of the therapeutic relationship and the intensity of the erotic transference will often determine how I respond. At all times I am mindful of the courage it takes to ask the question and do my best not to minimise, avoid or move away from it. Once my client is clear, although not always accepting, it opens up the possibility of exploring all and everything that arises in our sessions.

    I am always conscious not to exploit the transference in any way. As erotic transference can last over a long period of time, consistency, as well as my integrity and care for my client, is what has seen me through times when I have been on the receiving end of it. I don’t believe in changing the boundaries originally agreed in the face of erotic transference. That said, I do occasionally re-state  them, especially if the erotic transference is relentless. The intensity of feelings can be highly flammable and sometimes problematic and out of control. While my client is working through them, I feel it is essential to remind them that – no matter how strong or insistent their feelings may be – I will always adhere to the ethical code to which I subscribe, even when therapy has ended. This is part of my commitment to them, their safety and their well-being.

    Erotic transference emerges for many different reasons and not only in the therapy room. As with everything else, the levels of intensity with which it occurs varies dramatically. Where there is a reliance on another person for help, whether it be medically or any other situation where we are dependent on another for assistance or support, we can experience intense emotional responses. Often the client/therapist relationship is a unique experience, and for some, it may, at times, be unconsciously associated with a promise of love. Erotic transference often comes about as a result of a need to feel special amongst what they perceive to be a wealth of unseen competitors, whether other clients or people in my non-working world. Another reason for its occurrence is a way of regaining control of the relationship to win power and approval. I have also experienced it as a way of testing to see whether I am trustworthy. Some clients have a desire to be so powerful – so seductive – that their wish to conquer me would be their ultimate victory, showing that anyone can be corrupted. The fantasy can be persistent and persuasive as well as dangerous. Some clients feel gratitude and attraction and want to show their affection sexually. A client with sexual abuse in their history may confuse sexuality with intimacy. Whatever causes the transference to emerge, most clients are searching for an emotional relationship rather than a physical one. As the ‘love’ they feel is one way, it tends to echo a parental relationship rather than a reciprocal romantic one. Their feelings are almost always infantile and sensual rather than adult and sexual.

    By remaining gentle and clear, clients are able to work through all the feelings that they have confused with ‘love’. I see myself similar to the guides I have had in my own life, that when lost, have directed me home. By walking alongside my clients and remaining open and curious – with clear boundaries in place – my desire is that they can fully experience the erotic transference, whilst also trusting that I will bring them home safely to themselves and their loved ones, with tenderness and respect.

    Storr, A. (1979) The Art of Psychotherapy. London. Heinemann.

    Joyce, P. & Sills, C. (2001) Skills in Gestalt Counselling & Psychotherapy. London. SAGE Publications

  4. Thoughts From The Couch – Musical moments

    August 5, 2020 by Juliette Clancy Juliette Clancy

    By the time a client arrives in the therapy room, most have exhausted the strategies they have thought of to try and solve their issues. They are looking to me for support as they face whatever is happening in their world that is causing them concern and or distress. For me, doing therapy is like being an artist with the instrument being my client. What I enjoy about utilising skills learnt as a Gestalt therapist is that it allows me to be creative within a stable frame. I never want to be the therapist that relies solely on my experience, and as a result, stops taking intuitive and creative risks. I see how creativity and intuition can move the therapy from being stale and predictable to dynamic and alive within a few moments. Creativity is everywhere we look in life. I believe that effectual psychotherapy depends on me, as the therapist, being willing to step out of my comfort zone on occasions and, where relevant, take the risk in suggesting experiments that may or may not end up being useful. I am mindful aways that each of my clients is different. No story the same and what might work for one client might not with another. Any creative intervention or suggestion always includes my client and determines whether it is followed through or not.

    One of the things I have done over the years is to collect things that might be useful in sessions at a later date, a sort of library of tools. Music has been something that I have used in different ways and have a catalogue of both used, and yet to be used, experiments that involve sound in one way or another. What we know is that music can subtly bypass the intellectual part of the brain and directly connect with the subconscious. Depending on the moment and my intuition, music has often be both helpful in reframing a problem in a different light as well as allowing my clients to express in ways outside of the expected talking therapy. I have no doubt that each of us can think of a piece of music that can bring back memories. It is something most people can relate to and can have an immediate impact on our mood. We can be transported back years and bring back to our mind’s eye moments where music played a part in an experience we had. A piece of music or a particular sound can lift our spirits and console our soul; having a profound effect on our health, and well being, not only physically, but mentally and emotionally as well.

    I have several drums which I use in different ways. It is thought that drums were the first musical instrument used back in prehistoric times. Beating on things to produce a sound is said to have begun in the early stages of human development. Drumming is a way to connect to our bodies, to our spiritual self and one another. It began as an echo of the human heart. The first sound we hear is the sound of our mother’s heartbeat. The heartbeat is something that is shared by all of us and a reminder that in that way we are all connected. I have used drums with clients who have wanted to express emotions hidden deep within them that have no words. By banging on a drum, they can connect with feelings that are buried, hard to communicate or they feel they are too shameful to speak. I have used drumming as a way for clients to link back to their bodies. For those who have difficulty soothing themselves I have sat and gentle drummed the rhythm of the heartbeat and allowed my client to be metaphorically taken back to the safety of their mothers womb, and rest there a while. A gentle reminder that no matter how alone they may feel we are all connected to humankind through our heartbeat.

    Music is a magical medium and powerful tool. I have clients whose profession it is to play an instrument. I have sat and listened to them play their instrument bringing their individual quality and unique energy to the fore. By doing this, they are choosing to share with me an aspect of themselves that cannot be seen and often has no words. Clients have bought pieces of music for me to listen to. Music that they have chosen to use are part of a service for the death of their child, family member or friend; Music that represents feelings of deep loss, as well as music that represented their joy in overcoming difficult moments. We sit together immersed in the potent emotions that emerge, and I am transported to a different place, hearing their narrative in the notes played and the words sung.

    Now that I am not doing face to face sessions, as a result of the pandemic. I have noticed a difference in how my clients are ‘arriving’ to therapy. My sense is that the journey they used to take was time for them to leave one world behind before entering their private world of therapy. They had time to reflect and consider what they were feeling and things they wanted to address. Now they are often staying in the room they have been in all day, they are at home or in an office, swiftly moving from work to therapy. They regularly arrive on the call pre-occupied for varying reasons, and there is a distinct difference to their arrival. There is little time or space for them to come not having had a break, rushing from one environment to another. As a result, I have started to use wind chimes, with some clients, as a way to give them the time and space to settle in the therapeutic space. They can leave the busyness of their world and move from their intellect to their heart space, allowing us to connect and their work to begin.

    In the same way as music can inspire and delight, it can also soothe and relax. With clients who struggle with anxiety, sleep problems or trauma responses; music, as an external resource on which they can rely, can support them to reground and settle. Chanting and mantra can lead to sustainable healing. By regulating the rhythm of our breath, we can slow down the thought waves of our brain. By doing this, our body becomes more relaxed, thus reducing the limbic activity and stress response of the brain, a useful tool in moment of distress.

    I had a client who I will call Max, who arrived having recently been diagnosed with a terminal illness. Our work together took place throughout a couple of years and as he slowly deteriorated we needed to find alternative ways of communicating, as he started to go blind and lose the power of speech. We found drumming to be a useful and connecting way of enabling him to express his emotions. Sometimes frantic and loud and at other times a faint whisper of a beat. There were moments when he was filled with fear, and I would sit with him gently beating the drum. Imagining the sound of his mother’s heart beat, he would settle peacefully with his fears fading away with the belief that they were going to be reunited. The last time I saw him, his wife had called to ask if I would come over. He was slipping away and had asked for the sound of the drum. I took several drums with me, and for a while, his wife and I sat quietly drumming reminding him that he was not alone and that our beating hearts would be a thread of connection for always. It was beautiful, moving, sad, and a moment I will never forget. Our co-created creativity allowed us to be flexible and, as a result, deep healing and peace was achieved before the sun and earth tilted out of balance.

  5. Thoughts From The Couch – Jealousy – the green eyed monster

    August 2, 2020 by Juliette Clancy Juliette Clancy

    Jealousy is an underlying human feeling found in everyone, and yet of all the emotions few willingly admit to succumbing to the green-eyed monster without feeling an element of shame. Many people blend jealousy with envy as they are difficult to separate, but although part of the same picture, they are different. Jealousy is thought to be triadic (you, the thing or person, and the antagonist who might succeed in connecting where we have failed). Whereas envy is dyadic (you and the thing). Peter Van Sommers, in his book Jealousy suggests: “Envy concerns what you would like to have but don’t possess, whereas jealousy concerns what you have and do not wish to lose.” Envy occurs between only two people and is best summed up as; I want what you have. It could be the desire to have a characteristic, possession or another covetable thing that belongs to someone else, such as wealth, status or appearance. Jealousy, on the other hand, feels as it if touches the nerves lines to our heart, often creating more extreme reactions. Jealousy always involves a third party and is more generally associated with sex, a rival for attention or affection and our desire to protect what we consider to be ours whether possession or right. Both envy and jealousy involve comparisons that reflect a feeling of inadequacy and low self-esteem, which leads to the feeling of shame causing hidden turmoil that is often neglected.

    Jealousy is a common theme in storytelling and so universal in human nature yet, despite this, there appears to be much reluctance in acknowledging it. Some believe that the colour green has been linked with jealousy as far back as to the ancient Greeks. They concluded that jealousy developed as a result of the overproduction of bile, which turned human skin slightly green. What we do know for sure is that jealousy is a powerful force that, once trapped in its hold has the potential to lead people to do appalling things. Arthur Lynch muses ’Jealousy is one of the wickedest of all the passions. But reprehensible though it is, jealousy is almost rather to be pitied than blamed – its first victims are this who harbor the feeling.’ 

    When working with my clients, I see just how discombobulated they can become when in the whirlwind of jealousy. Outside of sexual relationship, people can become jealous for a variety of other reasons. Most common causes include sibling rivalry whereby we consider that one or more of our siblings receives more attention, or is favoured above ourselves, by our parents or caregivers. In the workplace, we can feel that our position is at risk with employers seemingly respecting others above ourselves. In friendships, we can feel competitive when we sense that someone else’s friendship is prized more than ours. This has been particularly prevalent emerging from lockdown when we have been allowed to create small bubbles of people who we can start to see. Some of my clients have been struck by how they haven’t been the ones to be initially included in these bubbles and, as a result, have struggled. They talk of their jealousy having witnessed others seemingly liked more than themselves. For those of us with perfectionism qualities, it is easy to compare ourselves to others fearing that their success will somehow negate or impact our own. These examples make it difficult for us to be generous in our desire for those around us to be loved, feel special or succeed as, somehow, with that happening, we are triggered into feeling insecure.

    It is normal to experience feeling jealous, but it is when we act on our jealousy by becoming destructive, intense or irrational that problems occur. Someone experiencing high levels of sexual jealousy often has difficulty trusting their partner. I have witnessed clients who have had their electronic devices bugged, spying devices installed in their homes, cars and phones being tracked. All aspects of their privacy invaded. When there is extreme jealousy behaviour can become abusive, and out of control at one end of the spectrum, people kill, hurt and abuse when in a jealous rage. Whatever level of jealousy any of us might experience what we do know is that it is a destructive emotion that often leads us to act in ways of which we are not proud and threaten the very thing that we hold dear by our behaviour.

    Two leading causes of jealousy are the fear of abandonment and low self-esteem. When we doubt our value, jealousy serves as an antenna that looks for evidence to prove our fear that others will be preferred and valued above us. That somehow we are not good enough, sexy enough, talented enough or loveable enough and that; as a result, we will be left.  We feed the messages that live deep inside each of us. They conspire to keep us from seeing our true worth causing us to be eaten alive with feelings of inadequacy and jealousy. As bathetic as it may sound, the start is within. With support, you can enter the solitary world of your unease, turning your attention to the roots of your jealousy. With time you can reframe your internal dialogue and choose to put your energy into feeding yourself with loving kindness that shelters you in moments of doubt.

  6. Thoughts From The Couch – The importance of boundaries

    July 25, 2020 by Juliette Clancy Juliette Clancy

    One of the most important lessons a parent can teach their child is about setting and respecting boundaries. Something that sets a limit or defines a line that is not crossed. Most often boundaries are a way of creating safety and for children to learn the importance of the words stop and no. Some parents are able to navigate this with ease, for others, setting boundaries is not something they really know how or choose to do. Many parents struggle with being consistent in setting boundaries and so children learn ways of being able to push and manipulate them. This has the potential for them to find it challenging in navigating the rules and boundaries they encounter when they become adults and enter society at large. 

    Without sufficient and reasonable exposure to rules and boundaries at home, a child may well struggle in knowing what their boundaries are and maintaining them. There are times when not having boundaries in childhood may have served to keep some of my clients safe as they learned that resisting could mean more pain. Often adults who have problems respecting or setting boundaries have developed these patterns early in their lives. These patterns are often taken into their adulthood causing problems in their relationships. Inevitably these often emerge in the therapy room.

    For me, creating a place of safety for my clients and myself is of utmost importance as I have a duty of care for the both of us. I see one of the most important building blocks to that is the ability  to have a synergetic dialogue between myself and my client, that helps to create a psychologically safe setting, from which they can explore and express all they need to. Boundaries are a vital part of this conversation as they set the basic guidelines of how both of us want to be treated and ensures that the relationship is mutually respectful and appropriate. 

    Setting boundaries is not something that I do to my client, but something that we create and agree on together. They are put in place to not only protect my client, but also myself. These are vital conversations, especially as many of my clients have had their boundaries violated, whether it be emotionally, physically, sexually or spiritually. As a result therapeutic perimeters are of significant importance in supporting my clients in feeling contained, supported and safe. They protect clients from being taken advantage of, especially as most people come to therapy when they are at their most vulnerable.

    Although in some ways therapy may resemble an intimate relationship, boundaries offer a structure that enables my clients to experience the therapeutic relationship as one where there are defined roles This makes it different to that of a relationship with a family member or friend. They remind the both of us that, by being therapy, there are things that our relationship will never be, but what it is can be is totally trustworthy. As a result of the inequality of power between the two roles of therapist and client not only are boundaries necessary to structure the relationship, but to protect the client from the possibility of a therapist’s unfair abuse of power.

    There are some boundaries that are never to be crossed. Beyond these fundamental limits, it is also important to be flexible enough to acknowledge that, within a proper structure and purpose to the therapy, there can be some fluidity to others. Always at the forefront of my mind is the welfare of my client. Hence I take into consideration their history, culture, personality and the issues that they bring to therapy. This can allow for us to create an agreement that can, when they emerge, incorporate beneficial boundary crossing interventions that fall on the cusp of ethics and technique. These are tailored to my clients needs in order to support the therapeutic process and the healing.’Boundaries are like fences; they are man-made and are designed to separate. Their function is to “fence in” and “fence out” to include and exclude. Being man-made, they can be constructed or dismantled, heightened or lowered, and made more or less permeable.’ (Zur, 2018)

    Therapy is a delicate and mysterious relationship with intense feelings and often intimate encounters that can surface during sessions. There are moments when disproportionate emphasis can be placed on small things in psychotherapy. Boundaries can assume all sorts of symbolic meanings triggering the clients sometimes childlike vulnerability in the relationship. Many times these gravitate towards the boundaries and friction about them. Each client matters enormously to me and I am clear that by having boundaries it does not mean that I have to be emotionally distant or unrealistically rigid. I believe that I can be warm, compassionate, and authentic whilst still maintaining a watchful frame around the work we do together. 

    As a therapist there is a fair amount of pressure to be able to hold strong no matter what. As I can never be sure who will walk through my door and what they will bring, I have to be aware of the potential for my own personal issues to be impacted. With the help of supervision I have worked through unsettling times when dealing with erotic transference, projection, transference, counter transference and my clients unresolved attachment issues that have pushed up against boundaries. As a result I am better able to manage the moments where I feel marooned on the rocky ground of intense emotion. I like to think of myself and my clients as fellow travellers, with therapy being instinctive, the relationship dynamic and ever-evolving. I see the work that we do together in negotiating and creating therapeutic boundaries, although not always straightforward, as a privilege. I watch as my clients starting to give themselves the gift of taking care of themselves and, in turn, their relationships. I take a moment to celebrate the miracles that appear.

    Zur, O. To Cross or Not to Cross: Do boundaries in therapy protect or harm. Pyschotherapy Bulletin, 39 (3), 27-32. Posted by permission of Division 29 (psychotherapy) of APA (updated 2018).

  7. Thoughts From The Couch – Existential crisis

    July 18, 2020 by Juliette Clancy Juliette Clancy

    Sixteen weeks has passed and the United Kingdom is still in the midst of a partial nationwide lockdown, in response to the COVID-19 pandemic. Although the daily numbers of deaths in the UK has fallen significantly, which is good news, it is hard to forget that there have been 45,119 deaths from the coronavirus in the UK, so far, with a reported 587,000 deaths worldwide, since the onset of the pandemic. We are going through a period of confusion as England loosens its lockdown restrictions, with the Government giving conflicting messages, resulting in no one being really clear as to what we are emerging back into. There is much pressure to get the economy back up and running and for people to get back to work amidst the whisperings of an expected second wave in the autumn. We are having to make snap judgements about what is safe and what is not when, actually we haven’t really got a clue. Most of us are struggling with the confusion, unpredictability and lack of control that is permeating every aspect of our lives and that is, indeed, challenging.

    Countless peoples lives have been deeply impacted by this pandemic, leading to losses of things that were previously taken for granted. There are many aspects that have rocked our sense of security and pose a significant threat to our way of living and structure. We are being challenged to be creative and re-evaluate our lives. Several of my clients talk of their lives being ‘totally thrown off course.’ For them they had felt they were on a path and whether it be as a result of losing their job, the death of a loved one, emergent problems in a relationship or just many weeks in isolation with much time to think, lives have shuddered to a stop and they perceive themselves to be totally unprepared for the next step. They no longer feel safe and secure in their external world, and suddenly their internal world is preoccupied with questions of meaning and purpose. It feels as if their sense of self has shattered and they are exhausted by feelings of loss, as they experience losing the secure footing on the path of their life, along with their joy.

    Most of us will experience times of stress, anxiety and depression at one time or another, and for most, these emotions pass through quickly, without having a debilitating impact on our lives. With an existential crisis the problem lies in us starting to question our entire existence, which often means that for a period of time we lose the feeling of being grounded and secure in who we are along with our purpose. Although it is fairly common to think about life’s profound questions, the crisis occurs when in asking ourselves these questions we experience breathtaking feelings of fear, loss, sadness and frustration as we struggle to find any satisfactory answers. 

    Anyone can experience an existential crisis. The common triggers are age transition, a life-altering or life-threatening event. Any of these affect all dimensions of our lives, the physical, personal, spiritual and social. Irvin Yalom an American psychiatrist, was a pioneer in the area of existential psychotherapy. He stated that mental health problems are often caused by struggles with existence. He identified four main themes that many people struggle with; meaninglessness, Isolation, death and freedom. With the trigger of existential crises often happening after something causes a person to realise their mortality or lose an ideal, it is no wonder that some of my clients are feeling a personal conflict from within, in the midst of this global pandemic. Experiencing an existential crisis is an deeply unsettling experience as it makes us question how we have lived our lives, the decisions we have made, the relationships we have chosen, our values, routines and habits and is often accompanied by questioning the point of life which can rock us to the core.

    Each of us will deal with the experience of an existential crisis in different ways and as a therapist I believe we need to have faced our own dark night of the soul in order to be able to fully support someone as they travel through theirs. Yalom poses; “We cannot say to them you and your problems. Instead, we must speak of us and our problems, because our life, our existence, will always be riveted to death, love to loss, freedom to fear, and growth to separation. We are, all of us, in this together.’ (Yalom :14). Suicidal thoughts and feelings are often part of an existential crisis, where we realise that we are not the person we thought we were and will probably never be the person we wanted to become. The feelings can take us to truly dark places as time feels suddenly of the essence and the prospect of recreating the life we truly want for ourselves impossible.

    David Wagoner in his poem ‘Lost’ reminds us that when we feel lost in the forest that is our life we need to stop and stand still; 

    “Stand still

    The trees ahead and the bushes beside you are not lost.

    Wherever you are is called ‘Here’,

    and you must treat it as a powerful stranger.

    Must ask permission to know it and be known.

    The forest breathes.

    Listen. It answers,

    I have made this place around you.”

    The value of an existential crisis, although deeply uncomfortable, allows us to re-evaluate our lives. It is important to let go of the too big questions and break them down into one step at a time. For those willing to explore all the emotions that emerge it can lead to a revitalised way of being. By addressing our mortality we have the chance to stop and look at our lives in a way that perhaps only a crisis forces us to do. By living existentially we see how life continues on with pain, death, sadness, regret and joy no matter what happens and that there is little point in trying to avoid this truth. Living alongside this, we can start to appreciate the blessings that come from the freedom to make changes and do things differently.

    With support we can lean into the fear and loss and breathe life back into our lives knowing that it is up to each of us to give meaning to our lives. As we are all connected in one way or another I receive the gift, as a reminder, that by stretching ourselves in new and creative ways our sense of self and subsequent well being grows. “In choosing to enter fully into each patient’s life, I, the therapist, not only am exposed to the same existential issues as are my patients but must be prepared to examine them with the same rule of inquiry. I must assume that knowing is better than not knowing, venturing than not venturing; and that magic and illusion, however rich, however alluring, ultimately weaken the human spirit.”  (Yalom : 13).  I feel thankful

    Yalom, I.D (1989) Love’s Executioner and Other Tales of Psychotherapy. London: Penguin Group

  8. Thoughts From The Couch – Let’s talk about sex

    July 16, 2020 by Juliette Clancy Juliette Clancy

    Although having sex is a perfectly natural part of life what I see in my practise how difficult most people find it to talk about. I have witnessed how sex is far more prominent now than when I was in my formative years. I recognise how the portrayal of sex in the mainstream mass media provides increasingly explicit and frequent images that keep sexual behaviour on public view and on personal agendas, yet rarely do we see sexually responsible standards represented. Perhaps not as prevalent for today’s younger generation, but in the private lives of my generation, many are still held hostage by old religious and cultural taboos.

    What I see is just how much the images of sex so widely and explicitly available impact us all in one way or another. Overtly or subliminally, sex now appears to pervade everywhere: in magazines, and newspapers, erotic and romantic narratives about sex are found in abundance. Casts of films and characters in print and TV advertising appear naturally comfortable with sex that has no consequences. So what fate for those who lack strongly positive sexual self-images and beliefs? Can an individual be simultaneously sexually competent and sexually dysfunctional? Negative body image, lack of desire, the inability to lubricate or be orgasmic, erectile dysfunction – these issues are rarely touched upon and if there are, it is usually to the detriment to the person struggling. The media message is that sex makes you happy and healthy – and if it doesn’t there is something wrong with you.

    My original training as a psychotherapist didn’t cover sex, sexuality, gender or relationship structures as topics. As I started out I noticed that it was rare for any of my clients to bring these topics to our sessions and that I never did. My upbringing tells me that sex is a private affair, something we do not talk about, not with family, friends and often not even with our partners. Reflecting back I see how my original training confirmed to me what my cultural and familial messages had been. Sex is a taboo subject.

    My wish to broaden my practise meant that I had to take responsibility and do additional training to become a psychosexual & relationship therapist. I wanted to gain a much greater understanding of gender, sexuality relationship structures, along with psychosexual issues, knowing that It is not for my clients to educate and inform me. I took the opportunity to explore my own sexual shame and embarrassment, along with my fears and assumptions. I see how my additional trainings have served me well over many years. I have been able to develop a language that enables me to support my clients in sharing and learning about their sexual selves. Having faced my own shyness I am able to see my clients through unbiased, non-judgemental and tender eyes. 

    Even though media portrayals of sex reflect an impractical, stereotypical, often commercial viewpoint, they are repeated so consistently that, for many, it is difficult to hold on to what’s real and not compare themselves with such unrealistic relationships and sexualised images, whether consciously or unconsciously. I work with clients addressing the comparisons made that result in an overwhelming sense of anxiety, shame and feelings of insecurity about self and partners, which inevitably filters through into sexual experiences and relationships in a negative way. 

    A lot of my work is in the undoing of what the mass media projects as models of masculinity, femininity, sexuality or what it takes to have the kind of relationship that supports and encourages satisfying sex. We live in a culture that dispenses unrealistic expectations – in particular of both sexual performance and body image, influencing how people relate to their body’s function, its appearance and, ultimately, how we utilise our bodies sexually.

    Many of my clients have not been raised in families or cultures where clear, accurate information was available or allowed, and therefore an element of their primary problem may be that they are battling with sexual ignorance, confusion and anxiety and that is when my role as educator comes in. I play a role in my client’s education by supporting them in understanding the physiological aspects of their sexuality, while at the same time witnessing their expectations, beliefs and taboos. It feels important to me that I am able to continually challenge stereotypical assumptions and expectations related to gender differences and sex.

    It is little wonder that the topic of sex and sexuality is often laced with guilt, shame and embarrassment. As a result clients find different ways of broaching the subject. They will use the telephone so that I don’t see their face. They send emails, texts and sometimes cover their face or look away when speaking to me. They close their eyes, ask me to look away. They struggle to find words and stutter over sentences. Some are so embarrassed they can’t speak of their embarrassment. I want to be able to guide my clients as they voice sexual concerns, confront physical problems and alter perspectives. Some of what they bring are recent concerns, and for others secrets shrouded in shame that they have carried for decades. As we work together they learn that,‘normal’ sex is varied and that sexual problems are not uncommon and can often be resolved. I hold space for them, trusting my unique personality combining experience, attitude and artistry. After a while, they start to relax, they can look me in the eyes and it is as if we are talking about the most natural of things.

  9. Thoughts From The Couch – Keeping curious

    July 13, 2020 by Juliette Clancy Juliette Clancy

    One of the things I often hear when working with couples is ‘it was so easy at the beginning, and now we feel so distant.’ They speak of the past when their relationship was new and exciting. Each meeting filled with a deep desire to get to know and connect deeply with each other. The time they made for each other. The deep conversations they had, going beyond the outlines of each other’s lives, interests, job, holidays. They shared their profoundest fears, desires and longings that allowed each to be vulnerable and connected. Between them, they carved out a life filled with their hopes and dreams. They spent any available moments together, lying in bed, letting the hours float away, content and warm in the love they had found with each other. They laughed, held hands, took pleasure in the small things. They missed each other when they were not together and looked forward to their reconnection. Constantly striving to know more. And then, over a period of time, no one really knows when, they started to struggle to ground their love in daily life. With no real conversations the two parties just hoped that somehow their problems would simply go away.

    What I see is how hard it is to hold the balance of being known and unknown in long term relationships. We all know how exciting and interesting the unknown is, and yet at the same time, many long for the reassurance of a long term relationship.There is something deeply comforting about our partners knowing what we like to eat, the sorts of things that we enjoy doing, and what makes us feel loved, but if we stop there, and rely solely on the belief that we know our partner, we can see how, excitement and interest wains.

    I often find myself reminding my clients that life changes us all. As a result, understanding each other is a lifelong process. Having children, illness, relationship problems, redundancy, financial pressures, along with the passage of time, means that no person is the same person you met one year ago let alone five, ten or fifty. If we fail to acknowledge that concept, we can see how easy it is for couples to lose their way in the everyday rise and fall of relationships. “For one human being to love another, this is the most difficult of all our tasks,” the poet Rilke wrote.

    What often emerges in witnessing couples is how much they take each other for granted. They assume that they can read their partner’s body language and predict how they think about things. They are no longer curious about their desires, concerns and longings or even facial expressions. Gone is the thrill of learning something new about each other. They make the mistake of assuming that they have arrived in the relationship, knowing what they need to know to sustain it, losing any sense of curiosity. Days become weeks, which become years and, each starts to feel a loneliness that gnaws away silently at their heart as they find themselves no longer intimately familiar with each other’s worlds. Samuel Johnson observes “curiosity is, in the great and generous minds, the first passion and the last.”

    The path of intimate relationships is not an easy one. Like the weather, they are in perpetual change and, we need to adapt accordingly. The time we initially devoted to our relationships gets interrupted by other things. The space that once belonged to each other, as a priority, is now filled with responsibilities, and a dangerous assumption that our partner is somehow ours. We start to neglect each other and no longer put a strong emphasis into integrating our relationship into everyday life. Instead of looking lovingly into our partners eyes, we check our social media, watch television, work, and even avoid each other, too tired to engage. We make so many other things a priority that there is no time or mental space to keep up with each others every changing worlds. No longer do we listen with curiosity. If we listen at all, it is not to understand, but to defend and reply. As a result important conversations get missed and, small hurts become aching resentments.

    I love what Jeff Brown writes in his book An Uncommon Bond. “You can connect from all kinds of places – energetic harmony, sexual alchemy, intellectual alignment, but they won’t sustain love over a lifetime. You need a thread that goes deeper, that moves below and beyond the shifting sands of compatibility. That thread is fascination – a genuine fascination with someone’s inner world, with the way they organise reality, with the way they hearticulate their feelings, with the unfathomable and bottomless depths of their being. To hear their soul cry out to you again and again and to never lose interest in what it is trying to convey. If there is that, then there will still be love when the body sickens, when the sexuality fades, when the perfection projection is long shattered. If there is that you will swim in love’s waters until the very last breath.”

    Whether it be fascination or curiosity or perhaps both, we need to remember that as much as we think we might know our partner, there is always more to learn. The couples I meet all long to be known. For their partners to stop and look at, and into them as they did when they first met. Curiosity is a rare skill, and one which, if practiced, can light the path as couples explore the tangled web of their relationship. It takes courage to step out of what has become comfortable. By trusting that by devoting time and genuine interest to the relationship, with generosity, future challenging terrain will be lit by a warm ray of hope. With this their love for each other can be held safe.

  10. Thoughts From The Couch – On being real

    July 9, 2020 by Juliette Clancy Juliette Clancy

    It has taken decades for me to develop my own style and become the therapist I am today. I remember starting out with all the fears of a green therapist, wondering whether I was good enough, what my clients would think of me and above all, whether I would be liked. I had received explicit instructions from tutors that if I was to work from home or an office, it should have no reflection of who I was as a person. I remember a colleague saying to me that I would be advised to change the way I dressed as ‘it was too colourful and flamboyant.’ It was a confusing time, but I was clear that just fulfilling a role, and or being a carbon copy of other therapists was not going to support me in being the therapist I wanted to be. The demand to be false, which never goes away, is something I leave outside of my therapy room.

    Today I still hold true to what felt important back then, that I bring my real self to the therapy room so as not to become stiff and unnatural. I see my job as a secure base to be a different sort of anchor that my clients have had before, and that in offering my client aspects of my authentic self, a trusting relationship can develop, for some, for the first time. For the most part, I am quietly confident in the knowledge that I am trustworthy, honest, compassionate and loving. In my view, in order to be able to benefit from the full therapeutic alliance that develops between myself and my client, I need to be able to hold both the professional and personal facets of who I am. I have incorporated my own self-development and self-awareness into my way of working, and although I have a toolbox to draw on, above all, I bring myself. After all, how can I encourage my client to be themselves if I am not willing to do the same?

    The ‘blank screen’ therapist is a myth. No matter how hard I might try, it is impossible not to reveal myself in the same way my clients reveal parts of themselves, within the first few moments of our meeting. Whether on screen or in the room, I self-disclose the minute a client meets me. The way we speak, dress to whether or not we wear a wedding ring. Our gender, age, tone of voice, accent, gives our clients an imaginable insight into who we are. When we work from home there are extensive self disclosures, such as financial status, clues about family and pets, possible hobbies and habits. Informing clients about time away from the office or a forthcoming holiday are also self disclosures that are unavoidable. In addition, as a result of spending so much time together, our clients get to know us well. Like a child who watches her mothers face to get a sense of mood or reaction, clients look and listen for similar signs from me, and there are many. I have learnt over the years that there are times I give away more about myself than I realise, and that is before I have even said anything. So, with that in mind, there is no point in trying to hide.

    As a therapist, I am deeply sensitive and intuitive. I seek to create a connection with my clients whereby we can be real with each other. To be real does not mean that I have to answer or appease all or any of my clients questions or demands. However, I will be clear and direct with them, adhering to the code of ethics I work within. Many of my clients have little or no experience of feeling that important figures in their lives have really seen and understood them, and so my being real and honest allows for an authentic exchange of thoughts and feelings. I use transference and counter transference as a way of exploring my clients subtle emotional tendencies. By doing that, it allows me to use my own process as a valuable compass in exploring my clients tender spots. Depending on the length and strength of the therapeutic relationship, there are times when I deliberately choose to self-disclose by either self involving, whereby I share with my clients my personal reactions to them, and what occurs during our sessions or self revealing, by disclosing information about myself.

    There are many differing thoughts around self-disclosure. I hear colleagues talk about self-disclosure in binary terms; you either do or you don’t. As I see it, it is not a question as to whether or not I should self-disclose, but more when should I self-disclose. In my experience, there have been many times when my self-disclosing has been beneficial to my client, and the therapeutic relationship. I am mindful of the when, why and how, as I don’t want my disclosure to have them feel they need to be concerned about me or burden them in any way.

    For many clients, what happens in the therapy room acts as a microcosm of their relationships in the world. Very often, a client will respond or react towards me in a similar way they do with others in their lives.The client who can push the boundaries constantly, despite being asked not to. The client who becomes angry when I don’t behave in the way she wants. The client who reacts as if they have been attacked when they were only asked a question. The client who appears to use a barrage of words as a way of keeping distance. The client whose words and actions are not congruent. In the therapy room, all behaviours and ways of being are noticed, and there is the opportunity for me to explore, challenge, notice such behaviours, the impact on me and, being mindful, share that with my client. Not always comfortable or well received, but rarely has it happened that the awareness has not, in someway, facilitated change.

    So often, clients come and share stories of tragic and traumatic events disconnected from themselves and their feelings. Through turning my awareness to my body and in turn my clients, I can gain valuable information about what might be happening in the moment with my client that she might or might not be in touch with. I can utilise this information to develop an awareness that complements the therapy. By sharing my feelings, it can be a useful way for my client to become aware of how detached she has grown from hers. 

    Above all, I want my clients to see me as human. I don’t claim to have my life sorted, have all the answers or not to have made mistakes, that I have had to learn to live with. “Even if it is initially useful for clients to idealise their therapists, we must help them and ourselves to see a separate reality. Modelling takes the form of presenting not only an ideal to strive for but also a real, live person who is flawed, genuine, and sincere. Occasionally, the therapist can use self-disclosure to close the psychological distance between herself and the client. Such sharing can often lead to increased feelings of mutual identification, as well as build great intimacy and authenticity, many clients are greatly relieved to learn that their therapists have been the victims of the same self-defeating behaviours that they are now trying to overcome “ (Kottler. 2017:22)

    As part of self-revealing, there are times that I choose to disclose the impact of what I have heard with my client. A moment when my client looks deeply into me, searching for some form of lifeline to understanding, calling for me to share my similar, or relevant, experiences, that allows her to see that survival is possible. I have learnt over the years that by revealing relevant personal information in an appropriate, controlled way, can have a powerful impact on my clients willingness to take risks. By sharing the feelings that emerge when my client discloses can be profound. When sitting with clients as they express their deeply held experiences, secrets and emotions, whatever they may be, and remaining open is not always easy. But by doing so, and acknowledging how it impacts me, they can sense that I too have experience of the powerful, gut wrenching feelings that can, at times, cause us to question life. At that moment they feel validated.

    As a therapist, I hear things that are deeply challenging and, at times, can sense things that are invisible to others. I see my gift to my clients is to model what it is to be human, authentic and imperfect. I believe this allows for moments whereby my client and I can sit, without needing to say anything, reaping the benefit of the rare and precious intimacy we have created together, built on the foundation of being real.

    Kottler, J.A (2017). On Being a Therapist. New York: Oxford University Press