Working competently as a therapist, as we’re all painfully aware, only happens after extensive (and usually expensive) training. This is a good thing. We’re being trusted with the wellbeing of our clients and it’s incumbent on us to take that seriously and act in their best interests. We’re not just ‘having a chat’; we’re working according to a range of models, applying theory, using our innate and taught skills, and being human in connection, all at the same time. And it’s hard work.
To make it that bit harder, we also add reflexivity into the mix. We’re constantly assessing ourselves; our feelings, interventions and thoughts about the clients and what we’re doing. We’re also assessing the presenting issues and the skills we need to draw on to meet the needs of our clients. Working within our competence is an important part of our ethical thinking and practice.
As a relationship counsellor and tutor, I’m frequently dismayed by counsellors who make the assertion that working with couples is akin to working with two individuals in the room and therefore requires no extra training. Yes, we’re working with two individuals, but we’re working in a relational space that brings an added dimension to the work. I’m not of the school that believes ‘the relationship is the client’, but the relationship is in the room alongside the individual clients and needs to be attended to. Understanding the relational dynamics requires learning on our part.
Understanding the limits of our knowledge and skills helps to keep clients safe. I wouldn’t, for example, work with children, as I don’t feel qualified to do so. But not working with a client group is easy if we’re able to state beforehand what the limits of our practice are. Sometimes, though, issues can surface with clients we’re already working with.
Here is where we need our reflexivity. As this new information comes into the room, we need to decide what’s best for the client. Can I hold this as part of our work, given we already have a relationship, or do I need to refer the couple on to a more specialist counsellor? This requires us to consider how the client may feel in terms of being perceived as ‘too difficult’ to work with or feeling abandoned by us at a critical place in the therapy. As with most things in our work, this needs to be addressed on a case-by-case basis in supervision.
Our competence also needs to be addressed in terms of working with cultural difference. It could be argued our core skills allow us to work with any client from any background. But this gets problematic where the presenting issues are related to the clients’ cultural backgrounds. Working with LGBT+ relationships may require understanding of the cultural contexts of those clients.
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As a therapist, I recognise the client is the expert in their life. I work hard to try and understand their world, while recognising I can never know what it’s like to be them in that world. However, having some shared understanding can be helpful. Being able to use shorthand and culturally relevant terms helps to build the therapeutic alliance. If we’re constantly having to stop our clients to ask them what a word means, or what an activity is, there may well be a rupture in the alliance.
Working with couples and poly groups adds the extra dimension of holding the context of more than one person. Even where I, as a cis gay man, work with two cis gay male clients, there are three different sets of experiences and beliefs about what being ‘gay’ means. Even language might be different – I’m comfortable with, and identify as, queer; many of my clients don’t.
Some clients see themselves as gay men, others may see themselves as men who happen to be gay. These are subtle differences, but important ones to explore, nonetheless. This can be a crucial part of relationship work, as we help clients understand that, despite their sameness, they’re also very different and have diverse understandings of their cultural context. And it can be these understandings that lead to some of the conflicts or issues they are having within the relationship
To work within our competence then can be a multi-layered experience. When working with a client group, it’s worth reflecting on what we think we know about that group and how this is informed by our often subconscious biases. As we try to learn about our clients, how much do we ask them for clarification, in effect making them our teachers, and what impact does this have on them and the therapeutic alliance?
I’m not suggesting we can only work with clients from our own cultural context, but we do need to make sure when we’re working with these groups that we have undertaken additional training or have educated ourselves outside of the counselling room. Making clients responsible for our education or knowledge places additional emotional labour on them, and this feels contrary to what we’re trying to achieve as ethical therapists.