By Dr Elizabeth Tindle FAPS, counselling psychologist
Tragic or stressful life events befall us all at some time. Part of the human condition includes periods of sorrow. As practising psychologists, our role is to support others through these challenging periods and to provide therapy to aid in our clients' healing. This brief article will address situations where the psychologists have their own tragic or stressful life events. It will present, with the aid of the author's recent personal experience, a model of how they can continue to work efficiently with clients whilst concurrently going through their own roller coaster of emotion during a personal struggle.
Therapists are sometimes tested to their limits, some succumbing to burnout or 'compassion fatigue' as it is sometimes known. However, given a caring work environment and suitable ingredients in their personal self care, enough resilience will be present to take them through the most taxing of situations. What's more, their parallel stressful experience with their clients can contribute to improved work quality as they become more empathetic and sensitive to their clients' needs. I shall use a recent personal experience as illustration.
In September 2002, one telephone call to the University Counselling Service transformed the subsequent two years of my family's life. Our daughter informed us that she had been diagnosed with cancer. When diagnosed with a terminal illness, 'anticipated' grief is slow and long drawn out.
To be available for and supportive of a patient, an ability to remain healthy and to keep functioning at a high level is crucial. This turns out to be beneficial all round. The carer remains whole, the loved one gets the benefit from this and the work environment provides the framework for staying connected and continuing to produce high calibre therapy.
During the various phases of my daughter's illness, I continued to work full time in my role as a counselling psychologist dealing with the usual array of distressed clients. The questions I will pose in this article are: What sort of support did my work environment provide to nourish me through the two years of struggle? What were my own coping mechanisms and how does one remain resilient? How did the grieving process affect my counselling with distressed clients?
My employer, a large Brisbane University, had an excellent Enterprise Bargaining Agreement in place for its staff, which enabled me to use some of my ample amounts of unused sick leave, long service leave and recreation leave in order to spend many hours at the hospital each day. The University also provides to all staff seven days per year of Personal Leave which can be taken in hourly blocks. My working day could be shortened, which meant that my colleagues were prepared to take up the slack if we were particularly busy. I consider myself fortunate in being part of a team of people who understand loss and grief. This support is not to be assumed, as in some similar settings the management can be less than understanding of the employee's needs and 'flexibility' is discouraged.
Occasionally I needed to take off a full day when it was my turn to accompany our daughter to hospital and stay all day for transfusions or lengthy surgical procedures. Three family members shared the support role so we could each continue working. Some people, in similar situations, have to take a complete break from work for a given time or will even resign from their jobs. Where full time care giving is necessary in the patient's home, there may be no option other than to give up work. This however can be an extra financial burden. The paper work attached to having a long drawn out illness almost necessitates the hiring of a personal secretary. The files grow fatter as the patient grows thinner.
Colleagues helped in many different ways. Those who believed in a God, prayed. A friend offered to give massages, another did hypnosis and relaxation. Some friends sent nests of feathers. Some gave books, colleagues gave clothing for a now much thinner person or knitted dozens of colourful beanies to keep her bald head warm. All the women in the church sat around knitting warm, woollen beanies for other patients in the cancer ward. People made meals and nutritious soup. Cards, presents and emails came in from near and far. The support and love was overwhelming.
Effect on therapy
My therapy changed in subtle ways. As usual in therapy, the therapeutic alliance was the essential ingredient in my clients' healing. I observed that I had developed more acute listening skills and my concentration enabled me to stay with clients through every nuance. Although one's own pain is never far from consciousness, it never broke through. It remained tucked away in some hidden recess of the mind.
There were a number of clients over the months who presented with cases resembling my own experience. These were the testing cases in which I may have deviated from the usual counselling process and obtained more detail than I would have under other circumstances. For example, John had been diagnosed with Hodgkin's lymphoma when he was nineteen years of age and had received radiation on the upper part of his chest. One year later he relapsed and tumours emerged below the irradiated area. Having first hand knowledge of this cancer and the treatment for it seemed to add to what I could offer.
A second client presented in an anguished state. Her 16-year-old son was to go to hospital for a biopsy on a lump on his neck. He also had a suspicious blood test. This suggested Hodgkin's Lymphoma. Déjà vu!! I empathised with this mother's shock and numbness. The knowledge I had gained first hand was of benefit at these times.
No matter how resilient a therapist is, it is imperative that they have a firm and rich foundation of activities and interests to ensure connection throughout the period of stress. A supportive network of friends in sporting and other clubs makes life much easier during these difficult times. Playing sport and swimming enabled me to remain calm and strong. Long swims provided a Zen-like meditation experience. Having time alone to write a journal was essential to peace of mind. I wrote poems which spoke of the mundane and the serious. They are emotional and confrontational but they closely monitor the daily progress of the disease and the lengthy healing process.
There are many personal stressors in life with which we have to contend. I was helped by being part of a large supportive organisation, however, psychologists in private practice may not be so fortunate. Maybe our State Registration Boards and our Professional Organisations need to step in to take the role that is currently played by larger organisations. Supervision and personal therapy needs to be available for those who require it, in order to support the psychologist through difficult times. Not being able to continue at work can be an additional financial stressor. Superannuation and insurance is needed to take up the financial slack at these times.
In this article I have tried to give a brief outline of two years of my own experience of personal grief in a caring work context. I believe it challenges the usual practice of saying that professional psychologists need to withdraw when they are going through stressors. In some circumstances this is not necessary where a solid foundation of support is in place, and management has adopted the necessary workplace practices to enable the employee to continue with his/her work.