I recommend you read my “Dissociation: How to recognise it” post prior to reading this post.
Let’s say you have been counselling “Mary” for several months. You have a good working relationship, and she now is beginning to trust you, so much so that she is letting you see that she has distinct parts of self who pop in to visit some sessions, leaving the part you thought you knew behind. Or she begins to dissociate in session, and you find it hard to ground her so she can get home safely.
What do you do, if you have never come across this before in your work? It is not ideal to refer on to a therapist experienced in this area before you have fully established that you are not the right person for her. She trusts you, and it may be difficult for Mary to transfer to someone new.
Listed below are some questions you might find helpful to consider, remembering you do not have to say yes to all of them to continue to work with Mary. But you will need to put her needs first :
- Do you have good personal and professional boundaries?
- Is your life full and rich, with social connection, fun and some exercise/self-care?
- Do you have some kind of inner resources such as spirituality, meditation, mindfulness, nature?
- Is your own trauma (if any) resolved to a level where it will not leave you vulnerable to burn out? Do you have access to on-going therapy?
- Are you familiar with the trauma literature? (see Books in Resources)
- Have you attended several trauma courses as well as basic trauma training?
- Are you committed to on-going trauma learning?
- Do you have some good references to refer to? (See Books in Resources section.)
- Have you got access to a supervisor who is skilled in trauma and dissociation?
- Are you able to be really honest in supervision about your own triggers and personal issues, without being guarded or defensive?
- Do you have colleagues you can chat to if needed?
- Are you committed to an informed relational approach to therapy, prepared to look at your attachment style/blind spots/strengths in this area? (See Working Relationally, an earlier post)
- Are you able to remain relaxed and focussed when a client is silent for a lengthy time in session?
- Do you have good strategies for grounding clients? Can you recognise the signs that this is needed?
- Are you aware of the body’s importance in trauma work? Do you understand the basics of neuroscience?
- Have you faced your own shame? (See The Secret Message of Shame in Books/ Resources)
- Have you got a clear model for emphasising client safety over “working through” the trauma?
- Are you committed to enabling clients to make informed choices about trauma-related interventions?
If you have found that you are (mostly) ready to grow and learn with the client, and you take the matter to your clinical supervision, you may find your answer is yes. If so, you are about to enter an inspiring, demanding and satisfying period of personal and professional growth. If not, then you might choose to refer Mary on to a colleague you trust to work with her. Either way, you need to remind yourself that you want what is best for Mary (and also for you).