Gill Jackman on the problems with long-term counselling

Woodcut of Alfred burning the cakes illustrating an article by Gill Jackman, a counsellor working in the Chew Valley, North Somerset

WHY YOUR LONG-TERM COUNSELLING DIDN’T WORK

Counsellors are ubiquitous. In many ways, this is a good thing. They are present at disaster scenes, present in schools, present at your GP surgery, your breast cancer clinic, your hospice and at voluntary agencies trying to help with grief, abuse, disability, learning difficulties, financial difficulties, educational difficulties. Just about everything. Often, in these cash-strapped and resource-led times, people turn to private counsellors for help. They pay between £35 and £80 per session and assume they will get something similar to what is described above. They have come for support and to be listened to. ‘Support’, ‘help’, ‘a listening ear’ are terms they believe describes what counselling is.

So far, so good. But what about the deeper work? In a culture that defines counselling as ‘listening and support’, how on earth will your counsellor grapple with difficult feelings that might arise about that counsellor herself? Clients nearly always think that their counselling is about ‘something else’ -- something that goes on or has gone on outside the counselling room, but the truth is that the deeper work gets done because what’s bothering you will emerge in some form you probably can’t really make sense of, between you and your counsellor. In long-term counselling it will be there, in the room, ready to be addressed in a really constructive way, probably for the first time ever.

Now this may not be what you want at all. In which case, short-term, or time-limited counselling is the very definition of what you’ll be looking for, and that’s fine. But if you wanted to reach into the angry you, or the doubting you, or the fearful you, current cultural assumptions about what counselling is (a listening ear or support) are going to sabotage your work before you get there.

A bit of background

In much the same un-thought-through way as people in our consumer society believe that the customer is always right, people seeking counselling often believe they are in control of what goes on in the counselling room. The current confusion about the term ‘counselling’ means that they don’t differentiate between long and short-term counselling. Because their counsellor is empathic and can see their perspective, the belief in themselves as a ‘consuming customer’ builds. Unfortunately, when things go on in the counselling room that they didn’t expect, they assume this is ‘wrong’ in some way. If they feel things they weren’t planning on feeling, such as anger, they think the counselling isn’t working. Especially if the anger is directed at their counsellor. From a consumer-led perspective, they believe that these emotions have come about because an injustice has been done to them. Or they doubt that their counsellor has their best interests at heart.

It’s a conundrum I face, now and then, in my own work. That’s why I’ve written this article. I’ve been practising for 25 years, over which time I’ve seen the following cultural beliefs take primacy in the public consciousness. 1.We are aware of everything that goes on in us. 2.We have such an unassailable right to be in control of our own story and actions at all times that we have no need to see what they are or how that story is in control of us.

Yet if you’re really struggling with parts of yourself you don’t like which will neither go away nor come under your control, going to see a counsellor for long-term work when you have these assumptions (above) will be a waste of money. This is because when difficult bits emerge and are responded to in a way you don’t like, the idea that you have no obligation to stay and work out what’s going on will allow you to simply walk away.

Q: But if these parts are unconscious (’split off’ is the term we use as psychotherapists), how will I know that they need to be addressed?
A: A very good question and one that can really only be answered by your counsellor, if she is good enough, through the counselling. And there’s the rub. It’s a catch-22 situation. Your conscious mind wants an explanation before it will commit to the process. Since it’s your unconscious mind we’re working with here, no explanation will satisfy. (Yet here I am, doing my best.) Ultimately, all deep counselling work involves examining the trust between you and your counsellor. But how will you stick with that examining if you reach an impasse and suddenly don’t trust her? See what I mean? It’s this, deeper work, that this article is trying to tell you about.

The truth is that working through this stuff with clients when things get rough between you is impossible if you have a ‘casual’ arrangement. If the split off part of you gets threatened, it can simply split-off completely (temporary relief) and dump itself on the counsellor. You are left blaming her for being no good or telling yourself ‘it wasn’t working’. The counsellor is left with no recourse to helping you see the thing that has been bothering you and often feels rather a failure (or if the blaming has been expressed after you have left, extremely angry – a process known as counter-transference. An occupational hazard). In psychotherapeutic terms, you have ‘split and dumped.’ And you’ve probably spent lots of money building up momentum to facing an important conflict only for it to fizzle away. Until next time, probably not in an expensive space specifically created for that purpose.

Let’s use a cooking metaphor. You’re baking a cake with lots of eggs in it. You cream your butter and sugar (lots of sugar, in counselling!). You beat in your eggs, with great care -- not too fast or they’ll separate and become lumpy and bits of it (you) won’t gel. You sift the flour, folding it in gently, to maintain the air. You’ve prepared a variety of ingredients in a way that, given the right temperature and container (cake tin and oven) will be transformed from said ingredients, into a new thing: a cake.

All set. You pour it into the tin, get the oven at the right temperature and put it on the top shelf.

Then, 10 minutes in, when the heat is on, you open the door. You leave it open. The cake collapses into a biscuit, it half cooks and no one wants to eat it. Least of all you. It leaves a taste of burnt carbon and baking powder in your mouth.

What a waste of carefully prepared and expensive ingredients.

Well, that’s what happens in counselling if you leave before you and your counsellor have engaged with what leaving means and come to an understanding (even if that understanding is that the client has decided they don’t like you. The room is like the oven. The kind empathy and understanding of the counsellor are the ingredients that prepare the cake. The feelings so carefully enabled have to be worked through IN THE ROOM).

Let me put this another way. Imagine you have been seeing your counsellor for a year. Everything she has said or done has led you to trust her. You believe she knows you quite well and you have had experience of her apologising when she’s misheard or got the wrong end of the stick. She has helped when you’ve had a (genuine) problem attending, moved a session when that’s been possible and always been there when you’ve needed her, responding as best she could. Then, out of the blue, you get really angry about something she’s said or done. In fact, you get so angry that instead of telling her about that you decide she can’t be trusted and never go back. You have opened the oven door. Your cake, in which you’ve invested so much time, money, care and commitment, will still not be fit for human consumption.

I want to make it very clear here that I’m talking here about long-term counselling. The reason I’m having to say this is because cultural assumptions have sabotaged the container (the cake tin and the oven) needed to enable the different parts of you to get to know each other and blossom (rise). These assumptions -- that counselling is just a listening ear, a drop-in I can take or leave because of how I feel in the moment -- have made it ‘normal’ and ‘acceptable’ -- to not treat the counselling process with the gravitas 150 years of research have actually imbued it with. The ubiquitousness of counsellors I spoke about at the start of this article has contributed massively to this dumbing down, doing a disservice to clients seeking long-term relief from lifelong difficulties.

Q: Yes. I get that, but still, how do I know I can trust her?
A: Trust her for what? Perhaps the question should be ‘can I trust her enough?’. Trust builds over time. Has she done what she said she would, so far? Have misunderstandings been mended between you before? Has she been there, as agreed? Has she been reliable, insightful, kind, so far? If so, there’s reason to believe she’ll continue to do the best she can.

The only way to address the problem of working with the unknown you is by defining evermore clearly what a counsellor expects from her clients. Yes. Counter-intuitive as that seems in this ‘I pay the piper so I call the tune’ culture, the healing of difficulties in relating to the world is only achieved through relating. And relating, if it’s relating anything other than superficially, is done through commitment and through sticking with the difficult stuff.

So let’s talk about agreements. Agreements made with your counsellor. You may have made an agreement at the start of the work but not taken it seriously. But it’s deadly serious. The only thing between you being a cake and a half-formed biscuit! In psychotherapeutic speak, agreements are known as ‘boundaries’ and the way many counsellors define boundaries (which they have had drummed into them, through their training) is to do with the room and the strictly held appointments. Most counsellors will also acknowledge that the ‘ending’ is very important, though they often can’t really explain why. Frequently, what they fail to do is have a clause tying their clients in to ending the relationship in a way that’s planned a few weeks ahead.

But imagine, for a moment, that you have a deep-seated part of you that is desperate not to be exposed. Yet you’ve come to counselling precisely to expose it, to take the heat out of it, to set it free, to say hello and make friends with it. There’s really only one thing standing between you and escape and that’s the agreement (or contract) you have with your counsellor. If you have a loose arrangement, it has no chance of being seen. Imagine, for a moment, that you have such deep seated grief, you believe it can’t be borne (This is another issue where the importance of ‘endings’ comes in). Instead of saying ‘goodbye’ to your counsellor and coming up hard against what grief really feels like in a planned way, with time to allow that (admittedly uncomfortable) feeling to emerge, you’ll just avoid it. Imagine that you’re angry with your counsellor but you have had a very clear and foregrounded agreement not to suddenly leave, but to return to your weekly session and discuss when precisely, you’ll stop coming. The very experience with which you’ve been unconsciously grappling can emerge, safely, and be engaged with and sat with and reflected on. It can (in psychotherapeutic-speak again) be ‘integrated.’ Terrifying as that may be, it really can, in a sort of inverse exorcism that finally demonstrates that your anger, or grief, or fear, or confusion is not the evil, destructive and entirely unacceptable force you thought it was.

This is why, in long-term counselling, we have (or should have) rules and we make (or should make) clear agreements. Agreements that are life-enhancingly serious. The more precise these agreements are, the more life-enhancing will be the outcome (although I’d only recommend this kind of therapy with someone whose been through this process themselves and there are fewer and fewer of these counsellors around).

I’ve tried my best to explain the unexplainable and it’s extremely hard to understand. That’s OK. You don’t have to understand it but if you were thinking about having long-term counselling, I’d recommend that you look at the boundaries set by the counsellor. You can, of course, leave therapy any time you wish, but please recognise that working through finishing, if you’re working in an open-ended way, is essential for an effective outcome. If the counsellor you’re working with hasn’t really set any boundaries or doesn’t hold you to them, find someone who does.