The conundrum of an ending before its time:the tension of limitation.

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.

 

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Transitions and the art of being unfazed.

The workplace treatment room at the cancer support centre where I also work is very nicely furnished and as non clinical we we can make it, and definitely a place where only sessions of client and massuese or herbalist happen , a defined time and space with clear beginnings and endings. The aim is always to massage with compassion and be open to supporting whatever arises for the person, and attune one’s self to offering one’s best response, as often empathic silence as wise words. However, once the person leaves, while you may have shared deep connections, as happens since most clients come regularly over months and years and inevitably feel safe and start to open up their hearts and their worries and concerns, when they walk through the door you move on to the next person, or to walk away at the end of your shift. Particular sessions stay with you , touch into your compassion and own heart’s stories but it is relatively easy to let it go.

My home visits are totally different and require special awareness, I am stepping into someone’s life when I ring their bell and they welcome me inside their home.I will not know what is happening until in it and in my 3 years on the job I have learned anything is possible!Sometimes there are big families, lots of people, conversations flying around rooms as folk banter, bicker and even row and and their dogs and cats weave in and out of legs , upping their ante if volumes of voices rise. Or maybe there are anxious daughters or aunties wondering what I am coming to “do”. I have had women lie having their massage while occasionally shouting their directions/ request/orders at family members in nearby rooms, taking calls to siblings overseas, one woman even had to start coaching her daughter in labour in hospital, insisting I carry on massaging her feet! Once I got used to it, we got along just fine. I may be in homes filled with life and know that for some clients, over time they are going to become very unwell and I will see their  physical deterioration and feel it in my touch. This is another layer of intimacy in the work. There are no walls , I am for 40-60 minutes with their whole self, body, mind and spirit with whatever arises.

Or I may have arrived into a home where a person is very near the end of their life and I am meeting grieving family members and needing to quickly assess if the room I am shown to can work for me to sit and support that person well. Quick decisions are needed by me: move furniture to make space , less light/more light, maybe the air is very stale, maybe a nice aromatherapy room spray ( I make them with water, a plant spray and an essential oil like rose gernaium, and often I invite the person to choose, find out what appeals from my collection of 20 or so ), would some music help, what may they like?I am meeting someone for the first time and they may look very unwell, I need to convey gentle compassion and not respond from unease or awkwardness.All these moments need me to stay unfazed, to adapt around what is happening and to keep my intention to connect, be open hearted , invite the person to relax into feeling safe enough in their body.All especially vital as I am going to touch this person, offer myself into their world. They will likely be in some discomfort even with good pain management, many try and joke or apologise for being so weak and unwell, and my work then is to be kind and compassionate, help them relax and feel well met by me.In these times, a peaceful gentle space opens up between and within us, my touch is very light, and flows to create soothing, feeling held emotionally as well as physically. Sometimes, in thse precious quiet moments I can feel that person letting go , of trying , of holding , of the brave face for the family and I focus my breathing to attune with theirs. Some deep healing is taking place in those moments, a profound being alive, present, right now, for both of us .

Some clients die and I may be with them a few days beforehand. One woman told me she was terrified, what did I think it would be like, how would she know when it was time? Her sister had told me she hadn’t spoken of her feelings about dying so I knew, in the way your hairs on your neck or arm rise when something acutely important is about to happen ,that my response was so important. Inside I felt fear but then I looked at her face, her eyes were shut, I was massaging her face, I felt her pain so I said I couldn’t know, but that I was sure with all her loving family there and medical team, she would be safe, comfortable and would know when she was ready.A  few tears rolled down her cheeks  and as I wiped them her breathing changed and she relaxed significantly as though a load had been shed. She rested for next 10 mins, I ended the session and we had a hug.She died the week later with her sisters with her massaging her feet and surrounded by love.

Some clients defy their diagnosis and this presents a different problem. My paid role is to offer 8 massages at home to someone with a palliative end of life diagnosis, and this may be extended a little but demands on caseloads make it always ,as with all 3rd sector work these days, a delicate balancing act. I have had 2 clients recently who have done far better than thier diagnosis would expect and then I have the difficult task of explaining why I have to stop visiting and to encourage them to access therapies at the centre. They grow to highly value their hour of surrendering their body to receiving the massage offered. I make sure they they are going to be driven to the centre by a relative, that they know it is not a long walk in to the treatment room and that their therapist will be wonderful, is trained to the same degree as me and usually it takes some resistance and then we get there. I have made a strong relationship with them, in the home you become involved , you see their personal things, their loves, kids, grandkids, husbands and wives.I hear their news, often it is happening around me while I work.

 

Life goes on within a palliative diagnosis, I have massaged a client as she wept her grief for her Mum’s passing and not making it back to be with her.I have massaged a Mum who told me all about her work organising the Caribbean carnival float for last years Jazz Festival, all the costumes she had made and we both knew she wouldn’t make this years. I have taught daughter’s how to safely massage their Mum, and made aromatherapy blends for them.I have had a very unwell and weak client suddenly rally and grip my arm with a strengh  that caught me by surprise and ask me , nicely, to massage very firmly as she didn’t want to feel the ticklish sensation of my light touch. Contra-indicated usually as too firm a pressure can break osteoporotic or bone metastasized bones and cause bruising in someone with low platelets. However I also knew she was very unwell, so increased to a safe enough pressure but enough to not irritate her.

This work is a priveledge, and always an opportunity to stretch and grow myself, as my clients let me into their worlds and we share time together. The more I let go of a sense that I am doing anything and just open up to offering my hands and self and see what happens, the more the alchemy of healing seems to arise.