Working as a therapist within the NHS or voluntary sector begins with limitation as the starter. Yes I can work with you but only for x. We might be able to bid for a little more time, but not that much.So lets see what we can do together.No pressure! As if our suffering comes packaged with a timer setting for resolution. It has usually taken a whole life lived already to have arrived at the impasse, the awful realisation that none of the ways you chose to cope with being human, and all the hard challenges that entails, work anymore.
For many, support networks are less easy to create now; although we are more connected as a species than ever, instant video chats one end of the globe to the other, information streaming from one touch of the keyboard, loneliness is the single biggest health problem in the West, and the ensuing depression and social anxiety that can develop.So prescriptions for mental ill-health rise and the urgent need for a joined up holistic strategy to address this phenomenon is a crisis. The national governments do not sincerely and seriously commit enough funding to start to tackle this very sad fact of 21st century humanity.With the meagre Government investments and inundated grant making bodies our voluntary sector does some amazing work on the ground with creative passionately offered work. The recession and retracted funding have forced organisations and statutory professions to join together to create packages of care , in partnerships.Yet it is a postcode lottery. I work in a holistic health project embedded and trusted within a community in an area of Edinburgh where the residents have a GP, that uses our massage, herbalism, counselling, yoga, community gardening, walking groups, support groups etc, social prescribing to tackle isolation, loneliness and despair.Yet in much of the rest of the city and surrounding communities provision is patchy.
Then there is the inequalities issue. About accessing counselling.
Fact one: That it costs at least £2,500, often more than £3,000, to train as a therapist and probably takes 3 years. There are no grants. Career loans perhaps, but the earning potential post qualification can be pretty slow to develop. So it is still the case that the majority of qualifying therapists are of a background where they can afford the fees.So culturally there is some missing ground. Yes the therapist’s skills of being human, emotionally intelligent with a warm caring heart ,are universal but empathy includes too some sense of cultural resonance. I have known clients leave support groups because the other members backgrounds were so different, it became another layer of difficulty.
Fact 2: Therapy costs around £40/hour,not a choice for those on low wages, even families with 2 wages often. 21st century UK is expensive. Some therapists offer a few concessionary places and still that is likely to be £25 / hour.The voluntary counselling agencies have average waiting lists of 6 months – year. If you are in crisis, that is a pretty meaningless offer.So it is a fact that for anyone with a restricted income , needing help now, accessing support through therapy is not a choice. Crisis phone lines yes, a walk in to the day care service at the psychiatric hospital yes, where they will have a friendly session but unless very psychotically unwell be sent home with an online anxiety management website and should things get really tough a psychiatric nurse here and there.
The limitation of the package.
Some clients of course arrive into their work knowing what they want to address, specific trauma, grief, stuck in some/most/all of their lives but many arrive plain unhappy ,with some personal struggle and pain of anxiety, depression, ,phobias, severe stress responses, self-destructive or sabotaging behaviours. Often referral has come from health workers or suggestions from friends, families, when no other options seem to be working.
If it is through the Employee Assistance Programme then 6, maybe 8 sessions are offered. If it is with independent charities it can be 10-20 sessions with a possible extension but rare to go beyond the mid 20s. Maybe that sounds generous, but with complex mental health suffering, with struggles with fear,complex PTSD, anger, trauma, abuse it takes a long time to develop a mutual trust and be able to dare to be in the work, showing the vulnerability, practising new ways of thinking, being and doing. Many clients come with these levels of suffering, struggles they have carried their whole lives.
Of course some clients can clear up enough in the packaged number of sessions to then go on to grow more in other ways.These are the relationships we can end knowing the job is done enough between us, that the person is going to grow into a much more fulfilling way of living.These are our islands of ease in our work.
The fact of carrying awareness that due to budget issues and waiting list pressures we are ending counselling relationships knowing the client hasn’t reached enough inner stability and authenticity to be free enough to go and create inner and outer fulfillment is tough. All caring professions face this fact, NHS staff are fire fighting limitation all the time, social workers struggling to cope with their caseloads, paperwork and the retracted benefits hardships. In our work though, we are so involved in the knowing of the other, the offering of trust and care,from our genuine selves, the stewardship of supporting a client’s daring to really show us how it feels, how it is. I believe that as a profession therapy needs more research about the effects for both the clients and the therapists of working with the limitatation boundary, declared at the beginning of the forming of the relationship.Sitting ending a last session knowing more time was needed and isn’t available wouldn’t work in other health treatments, imagine a broken leg being half- set, a hip partially replaced.
Alzheimer’s and other dementias and mental health conditions are the most critical underfunded health areas today and yet statistics tell us these 2 are now the main super diseases of our time and growing fast. What will it take before mental health gets bumped up the list, the stigma dissolved and investment in providing more affordable therapy services to anyone who needs it becomes a reality?
Therapy works. It works because it is human connection, space to share all the ways we screw up, got screwed, get confused, act out our dysfunctions, break our hearts, strangle our spirits and where we get the honesty and compassion of someone with the integrity and just enough wisdom and skill to reflect and show us how to dare to shed armour, be in vulnerability. All good therapists have/are still clients too, recognising that we change all the time, have blind spots and we make sure we are in supervision too, so we get to keep a check on how we are in our work.It is a profession marked by dedication to excellence for the people it serves.