It’s a long time since I last blogged partly because of finding the time and partly because of issues to do with my health.
I have been meaning to write, for a while, about having a near-death experience, coming back from it, finding myself disabled in a relatively minor way (I am shirt if breath and gt chest infections easily) and what that means for me as a psychotherapist.
Irwin Yalom, in his book Staring at the Sun, writes that facing one’s own mortality, staring death in the face is liberating. I can see what he means, but also think that the key is facing up to the terror of death. For me, this is less about not being and more about absence – not seeing grandchildren growing up is big, for example.
So the question is, does this make a difference to the way I approach being a therapist. I have thought long and hard about this one and the answer is both yes and no. I am still fundamentally the same therapist, with the same approach to my clients and my relationships with them that I always was. At the same time, I find myself often more focused, more intensely ‘in the room’ with the client. There is a balance to be achieved between my own desires to be well, physically and mentally, after the trauma of ICU and my realisation that I need to adapt to how things actually are — the fact that I do get breathless, that I do find things harder to do than I used to, that I take longer to do things and often have to stop to catch my breath. Some days are harder than others — when I wake up feeling that I don’t have enough oxygen. But I am learning to pace myself on a daily basis, and in learning to do this for myself, I am able to hold my clients through their struggles better.
Disclosure is a fraught thing for psychotherapists. Few would now adhere to the notion that we should or could be ‘blank sheets’ written upon by the client’s projections. However, when to disclose and why remains difficult. For me, this means that all my clients need to know that I have been ill and am likely to be ill again. They need to understand that some days I will be overcome by fatigue and that my ethical code means that I may take days off at short notice rather than work when I am physically or mentally unable to provide the necessary containment or, indeed, challenge. At the same time, they need to know that I am there for them. The line between telling them too much about my health, and too little, is a fine one. Virtually all writers about self-disclosure in therapy take the view that any disclosure must be in the interests of the client, rather than the therapist. I think that the dividing line is a bit less clear than that. At each point, there is a judgement call to be made. Does this client need to know that? Now? What, how much and why? Sometimes the interests of the therapist and the client are congruent. I need my client to understand something of my condition and they need to understand it in order to be able to work with it. Sometimes that is less than clear.
What’s more, dealing with issues that arise from a therapist’s illnes is far from simple. It is all too easy for the client to fall into looking after the therapist, taking care not to upset her (me) and to put on one side as unfair feelings of abandonment. Inviting clients to explore the negative feelings engendered by the therapist’s Illness can be difficult but is a necessary part of the process. What’s more, working through the client’s feelings can also be a way of coming to understand one’s own. As Karen Maroda once said, when the therapist is fully ‘well’ that is the time to retire from the profession.
So the delicate balance of psyche and soma, physical and mental distress, are played out in the every day experience of therapist and client in the therapyroom and the combination can create a greater sense of spaciousness, but the risk is that rather than open things up, disclosure will close them down. Thirisks the