In addition to the professional factors, some of which have been outlined above, are the personal ones. Many writers in counselling and psychotherapy argue that the therapist should ‘leave themselves at the door' of the therapy room. While this expectation might be theoretically more consistent with some schools of therapy, for example, psychoanalysis, the reality might instead be argued that no practitioner, regardless of their theoretical orientation, can ever be truly objective in a helping relationship and therefore, the subjective experience of the practitioner will inevitably be present. In this context, there are some specific personal challenges practitioner will need to address:
- • Personal experiences of mental health crisis
- • Personal views in relation to suicide
- • The degree of dissonance with agency policy
- • Self-care and ongoing coping strategies
Personal experiences of mental health crisis
While some would have us believe that there are people who experience mental health difficulties, and then there are the rest of us who are, presumably, “sorted”, this is, of course, nonsense. In the same way we all have our physical health to attend to, which might include being well, temporarily impaired or struggling with longer-term conditions, the same is true for our mental health. In that frame therefore, the practitioner’s own experience of mental health difficulties and how they have been able to navigate them - through their own support and/or help from others - will play an important role in shaping how they respond to mental health distress in others. Specifically, the extent to which the practitioner can find a narrative for their distress, again, either for themselves or for sharing with others, will be important here too. Put simply, if we have been able make sense of our own distress through self-talk, or by talking with others, that is more likely to position us to provide that space with our clients.
The concept of the “wounded healer” (Larisey, 2012) is well established: that those who find their way into helping professional roles do so, at least in part, because of their own previous “wounds”. It is not uncommon however, drawing anecdotally over 30 years of practice and support by some limited research evidence (Adams, 2013), that helpers often struggle to be helped themselves. Relationally therefore, one might speculate, as to the impact of a helper who struggles to verbalise their own distress on their capacity to support another do the same.
Personal views in relation to suicide
Suicide is one of those topics that is rarely viewed through a neutral lens; people can often have a visceral response to suicide, in the same way they can about death more generally. The narrative mechanisms developed through social story-telling to soften the truth of death are everyday apparent: going to sleep; being at rest; passing on; and so on. Add into the mix the stigma that still surrounds mental health - albeit to a lesser extent recently perhaps - and certainly the historical echoes of the shame of suicide when it was seen to be “against God”, or an illegal act, still abound.
Practitioners are not tabula rasa when it comes to suicide therefore, and their personal views about suicide - ranging from believing people have a right to end their own life if they have the capacity to make that decision, through to the choice of suicide never being acceptable - will be present in the helping relationship, explicitly or implicitly. Such views will be shaped by a range of factors, such as: faith; music; literature; experiences of suicide personally or amongst family and friends; training, and so on. The challenge is for the practitioner to be willing to engage with an internal reflection so that their views are known to them and held accordingly in the helping relationship so that they do not consciously, or unconsciously, shape the nature of the help being offered. Supervision, which is discussed in a little more detail later (and in Helps, this volume), is important here in helping practitioners to reflect on their own philosophical, practical, and theoretical relationship to suicide. Important here is Shea’s (2011, p. 4) observations that,
... when a [practitioner] begins to understand his or her own attitudes, biases, and responses to suicide, he or she can become more psychologically and emotionally available to a suicidal client. Clients seem to be able to sense when a [practitioner] is comfortable with the topic of suicide. At that point, and with such a [practitioner], clients may feel safe enough to share the immediacy of their pull towards death.
The degree of dissonance with agency policy
In the light of personal experiences of mental health crisis, and personal views about suicide, it is not uncommon for practitioners to find themselves working in settings where their personal views are contradictory with those of the agency. This has to be professionally managed, with practitioners sometimes having to act in a way inconsistent with how they might personally. My own research amongst counsellors suggested however, that when there was a conflict between a counsellor’s own view of suicide and that of the agency within which the work was taking place, they tended to favour their own view, disregarding that of the agency (Reeves and Mintz, 2001). This, of course, raises some difficult professional and ethical questions.
Self-care and ongoing coping strategies
It is an ethical requirement of most commonly referred to ethical frameworks for practitioners to pay explicit reference to their own well-being and self-care. Formal supervisory arrangements, again often a requirement of professional bodies for many different professions, play an important role in ensuring the restorative care of the practitioner. Beyond such formal arrangements however, it is imperative the practitioner puts in place their own strategies for self-care. Failure to do so often leads to vicarious trauma, compassion fatigue and burnout (Marriage and Marriage, 2005; Moore and Donohue, 2016). Helping professionals are not immune to the dangers of dissociation, where the felt experience of the helping relationship is lost to a sense of attack, anger and resentment of clients who are perceived to be “too needy” or “manipulative”. In this context, the capacity for an empathic and meaningful narrative is lost.