I was ill recently and had to cancel all therapy sessions for a six-week period. Before I returned to practice, I started to consider how my absence may have impacted on my clients and what reception I might receive from them. I also considered to what extent I was going to disclose my experience to my clients, bearing in mind that any disclosure should be primarily for the benefit of the client, not me. I would describe myself as a relational therapist. I was therefore acutely aware that a negative effect on our relationship may destabilise the therapy itself.
 The therapeutic press is littered with advice about what the therapist’s absence may evoke for their clients, how this hurt may present itself within the relationship and how the therapist can best care for the client. For example, the therapist’s sudden absence may recreate feelings of abandonment, which may lead to the client feeling aggrieved. In such cases, the client may become angry or even withdraw from the relationship. For those clients whose history means that they expect to have to look after themselves and find it difficult to rely on others, the therapist’s absence may reactivate their self-sufficiency. If this happens the therapeutic relationship needs to be re-established for the client to regain a feeling of security within the therapy. I also anticipated that some of my clients may have felt extremely disconcerted by the feelings of uncertainty that my absence created. For those clients who have been less able to commit themselves in the therapeutic relationship, my absence may not have impacted on them at all, other than the potential inconvenience created by the change in their weekly routine.
 I returned to work braced for these potential responses. I anticipated anger, aware that it may take a few sessions to become present. I watched for signs of withdrawal, eager to re-establish relationship quickly. I prepared myself for the anxiety I might meet in clients who felt unsettled by the unexpected break. I even attempted to predict which clients may report no sense of loss in my absence, partly to protect myself against the feeling that I might not matter to them as much as I hoped! I had also planned that I would be as honest as each client appeared to need me to be. I realised that there was not going to be a stock answer I could provide that would be appropriate or adequate to each client relationship I have.
What I was not anticipating was that many of my clients displayed the need to provide care for me. I met with withdrawal, self-sufficiency and a little anger, sure, but in the midst of these emotions appeared something different: A genuine need for certain clients not only to provide care but they also needed me to receive their love. Like many psychotherapists, I have a need to provide care for others which isn’t entirely altruistic. Through caring for others, I can keep attention away from myself as I’m not good at being cared for.  So, what happens when I need care? Is it acceptable for my clients to care for me, or for me to be cared for by my clients? Providing care and showing love for another is a basic human need, especially in a relationship which matters so much, but the therapeutic press seems to not speak of it all. Last December, Keys wrote an article for the BACP journal Therapy Today asking ‘Where is the love in Counselling?’ She has created a formulation to help therapists understand the love they give in the therapeutic relationship but didn’t pay any attention to the love that the client wants to give, the care they show for the therapist.
I have no answers to offer. I would just urge therapists to consider how they receive their clients’ love and care. To not receive it may well be felt as a rejection by the therapist and would be very detrimental to the relationship. I hope, for my clients’ sake, I have successfully navigated a path through my return and managed to maintain a therapeutic relationship. Maybe only time will tell!
In future, when I return from a period of illness, I will prepare to receive my clients anger, their withdrawal, their self-sufficiency but I will also prepare to receive their love and care, however alien that may feel for me!
 
Keys S. (2017) ‘Where is the love in counselling?’ Therapy Today 28 (10) pp34-37

In the psychotherapy and counselling community, we often talk of the ‘issues’ which bring clients to us. Indeed, even my own advertising speaks of working with clients ‘presenting with a variety of issues’. But what are these ‘issues’?

The ‘issues’ brought may be depression regarding how to deal with retirement, "my job is under threat", "my partner doesn’t understand me" or "I don’t know where my life is going". Fundamentally, the underlying question to all of these seems to be "Is my life enough?" 'Issues' such as anxiety about going out, about staying in, about life in general all seem to relate to the underlying fear of “my life feels too full, how can  I stop from feel overwhelmed by it”.
In my experience, therefore, people come for therapy asking one of these two essential questions:
           “Is my life enough?” 
           “My life feels too full, how can I stop feeling overwhelmed by it?”
Some people have periods of experiencing both.

We all live in a complicated world, with life seemingly taking over: Can we have any control over it? We can lose sight of the choices we have in the melee and confusion of modern life. Therapy can help return you to yourself, to help you remember how to find the answers to the difficult questions that life presents, and remind you of the choice and control you have.

Through talking within a supportive, therapeutic relationship, you can remember what it is that gives your life meaning, so you can make decisions about whether your life really is enough, and, if not, what do you want to do about it? Is there really too much going on to deal with, or have you simply lost sight of what feels important and the choices you have to put some of these responsibilities down?

Together, we can work it out.