Saturday, 4 April 2015

About counselling

This is Sarah - the one who set this blog up! I've decided to write a post myself, about counselling....
I remember the first time I mentioned in a blog post that I was going to counselling. I wasn't completely sure I wanted to share this information as I was a bit embarrassed. I would never, ever think this about anyone else, but when it came to myself, it felt like admitting I was going to counselling was admitting failure, or that I am weak, or damaged. (There are moments I can still feel like that - but not because I really believe it. It's because there is still so much stigma about mental health in our society.) But I shared it anyway, and have continued to share it whenever it's relevant. It's an important part of what's been going on in my life over the last year.
I first went to counselling at my local cancer support charity because my mom had died from breast cancer, and I had been referred for genetic testing because of family history of breast and ovarian cancer in my family. I was considered "high risk". It was all a lot to get my head round. My genetic test result came back as negative - ie, there were no faults in my BRCA1 or BRCA2 genes which were the two that were most likely to be to blame for a family history of cancer such as mine. A couple of months later I was diagnosed with breast cancer myself anyway at age 33. As you might guess, I kept up the counselling sessions.
As I said, I often mention counselling in my blog posts, and I also often mention it in discussions in the Younger Breast Cancer Network UK forum. As a result, people regularly ask me questions about counselling, and I thought it might be helpful to write all about it here. I'm structuring the post as a kind of Q and A and I'm writing it with other young women with breast cancer in mind. If there are questions I haven't answered, please ask away and I'll add to this. (You can post a comment on here, email or tweet @youngbcblog.)
What type of counsellor do I have?
Not normally the first question people ask me! But I think an important question to answer first here. There are lots of different approaches to counselling. For example:
  • CBT - Cognitive Behavioural Therapy. This looks at the way you think and behave, helping you to understand how the way you think affects the way you behave, and vice versa, and then identify ways of making changes that will help you. It looks for practical solutions to problems, and you get set "homework"! You can read more here.
  • Psychoanalytical and psychodynamic therapies. These approaches are based on an individual's unconscious thoughts and perceptions that have developed throughout their childhood, and how these affect their current behaviour and thoughts. (Think Freud.) You can read more here.
  • Humanistic therapies. These focus on self-development, growth and responsibilities. They seek to help individuals recognise their strengths, creativity and choice in the here and now. You can read more here.
The type of counsellor I have is a person-centred counsellor - this falls in to the category of humanistic therapies. I landed a person-centred counsellor by chance. I didn't even realise until my first session that there were different kinds. Me being me (nosey, always want to know what's going on) I promptly went away and read all about it and I was very chuffed I got a person-centred counsellor! The thinking behind the approach sat really well with me and felt right for my situation. In a nutshell, a person-centred approach to counselling is a non-directive approach. The counsellor is not there as an expert - this is about me, and I am the expert on me. The counsellor doesn't dictate what is discussed, that is up to me, I lead the conversation. The counsellor is not there to advise me or tell me what to do - I know best. Sometimes it might take me a little while to work it out, but that's what the counselling helps with. It helps me work through what's going on in my head, how I feel, and what is right for me. I'll explain a little more about how in some of the answers below. (And if you're interested in the person-centred approach I recommend reading Carl Roger's book "On becoming a person".)
What is counselling like?/ What happens at counselling?
You talk and the counsellor listens! It took me a little while to get into it - I'd never been before so I didn't know how to "do" counselling. I felt awkward talking about myself - it felt self-indulgent and a bit rude. I'd always ask the counsellor how he was at the start of the session - it felt rude not to! I also wanted advice and answers. I'd repeatedly ask him what he thought (still do actually!). I wouldn't know how to talk - even if I had loads on my mind, I didn't know how or where to begin. But it comes more naturally once you get used to it.
I thought counselling was talking and sounding off. But actually it's very different to normal talking and sounding off. I do a lot of both to my friends (and anyone who'll listen really!) but I don't always feel better for it. The difference in counselling is the part the other person - the counsellor - plays in the conversation. I don't get advice and solutions, I don't get platitudes. I'm not being judged. I talk, and what the counsellor does is listen to me very carefully, and at times, make observations, or ask questions. It might not sound like much but these things make for incredibly helpful conversations. More on why below.

How and why does counselling help?
You can say whatever you want without risk of offending or upsetting anyone. This in itself can be really helpful at times. A massive rant, where you can name names and be as blunt and unfair as you want about everything and everyone - and no repercussions!

You don't get offered advice and solutions. People in your life who care about you tend to do this at every opportunity whether you ask for it or not. There are times you need advice and solutions, but there are also times you don't. Sometimes you just need to talk, and be heard and understood and sometimes you need to talk because just talking things through helps you to process and understand things and reach conclusions and decisions yourself. At these times, the last thing you need is someone else's advice and suggested solutions! They tend to be based on the other person's experience and personal baggage and so can leave you feeling fed up, frustrated and as if you haven't been heard. You were talking about you and your situation! You didn't ask for their advice based on their situation which they now want to tell you all about! Shut up! Well, at counselling, you don't get advice and solutions, the counsellor never talks about themself - and it's wonderful!

You don't get offered platitudes. Doesn't matter what you say at counselling, you won't get a platitude. That too, is wonderful. Platitudes are what people throw back at you when there's no advice or solution. For example: 
You: "I'm so upset, I have cancer and I might be dead by the end of the year."
Other person: "You aren't going to die, I just know you're going to be fine. Besides - we could all die at any time. I could go out and get hit by a car tomorrow!"
A couple things to say about this. First of all, I have lost count of the number of people who have told me they might get hit by a car, or bus. Apparently this is on everyone's mind, and the way most people think they are most likely to die? Oh please! Look, listen, look again when you cross the street, and stop telling me you might get hit by a car!
Secondly, they don't mean to do this, but the person has basically told you to change the topic, because, as there is no solution to your problem, they don't know what to say, so now the conversation makes them feel uncomfortable and they want it to stop. This is why platitudes are so annoying - they are meaningless and they shut you up.
At counselling, the response to you saying "I'm so upset, I have cancer and I might be dead by the end of the year" won't be a platitude that shuts you up. It'll be either quiet, to allow you to continue talking, or if you don't know what to say next, it'll be a question or observation that enables you to continue, if it's something you need to talk about.

The counsellor is very good at listening. VERY GOOD! And as a result what they can do is make observations that help you to move forward in your thinking, consider other perspectives, understand what things mean for you and so on. They can seem like really subtle points, but some of the things that a counsellor says can make a profound difference to the way you think and feel. They're the kind of observations and questions you don't get elsewhere.
As an example, after my mom died I was carrying a lot of guilt around with me for not knowing how ill she was. She'd kept a lot from me. It was over a year after her death and the guilt was playing on my mind every day. I told the whole story of her cancer, from diagnosis to death, and the year since her death, in great detail over a number of sessions. The counsellor barely got a word in, but those he did were so helpful. I remember him pointing out I say "should" a lot. For example, I should have known how ill she was, I should have done this or that differently, I should feel this way or that. He would ask, "Why should you?"
Another result of the counsellor being so good at listening, is they can ask you some very thought provoking (sometimes quite provocative) questions. For example, my counsellor asked me "Can you make someone tell you the truth?"
These things might not seem like much, the little observations, the questions like that - but actually they are incredibly powerful and effective in helping you to process thoughts, see things from different perspectives, and ultimately deal with things and move forward. I'd been tormented by guilt for over a year after my mom died - in a matter of weeks of counselling, it had gone.

And all of this is happening in a safe place -you aren't being judged, and nothing changes in the outside world. There are no repercussions. No-one else will ever know what you've said (unless you decide to tell them.)

Should I go to counselling if I don't know what to talk about?
Yes! I didn't know where to begin. It's ok because the counsellor is there to help you to talk. They're used to people turning up and not knowing where to begin or what to say. I started just by telling my story, in great detail, from start to finish. It was the counsellor's questions and observations that helped open the conversation up. I'm used to counselling now so I generally arrive and launch straight in to what's on my mind and my own observations about it and he adds in his own along with questions. It's brilliant.

Who goes to counselling?
More people than you realise, and people you really wouldn't expect are going to counselling! Think of the most together person you know. Chances are, they've been to counselling. When I first started, I admitted it to a friend. She told me she'd been to counselling before. I couldn't believe it. I then admitted it to another friend. She had started counselling recently. Over time I discovered that lots of people I know (not including the ones who have been diagnosed with breast cancer!) have been to counselling or been on anti-depressants at some point in their life. It's more "normal" than you'd think - it's just that most people don't talk about it.

Is counselling just an American thing?
Nope! Just seems that in the USA people are much more open about it. Counselling or therapy isn't seen so much as something "crazy people" do. It's something anyone might do, because we are all people, we all have emotions including the bad ones, life can be horrible, and counselling helps.

Will it open up the floodgates?
If you have floodgates that need opening then it might! In my experience it hasn't. The only time I cried at counselling - and it wasn't full on crying, it was more red/watery eyes and a wobbly chin - was when my beautiful dog was diagnosed with cancer. That was the final straw at that point! Other than that though, there haven't been tears. Just me unpicking everything that's going on in my head.

Where do you go for counselling and how much does it cost?
There are a number of options. If you're a young woman with breast cancer in the UK, then chances are, not too far from you, there is a cancer support charity. Some areas of the UK have places called Maggie's Centres. Some have places called The Haven which are specifically providing support for people with breast cancer. Others, like where I live, might have individual local support charities and centres (the one near me is called Coping with Cancer in Leicestershire and Rutland.) If you can't immediately find a centre near you, Macmillan should be able to advise.
My personal advice would be to seek counselling via a cancer support charity in the first instance as their counsellors should be experienced in supporting people with cancer. But there are other ways of accessing counselling, for example via your GP, and sometimes through work. (If you have private healthcare cover, counselling may also be covered as part of this.)
Generally accessing counselling through these routes should be free of charge.

You can of course also look in to paying for counselling sessions. If this is something you want to explore then these websites might be of use:

Counselling Directory 
Any other questions I might be able to answer?
If there are questions I haven't answered, please ask away and I'll add to this. You can post a comment on here, email or tweet @youngbcblog.

What are your experiences of counselling?
If you are a young woman in the UK and have had counselling to help with dealing with a breast cancer diagnosis, treatment, life after cancer etc and want to share your experience on this blog (you can do so completely anonymously) then that would be wonderful! Please get in touch at

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