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• Primary care counsellor Amelia is online with her supervisor of six months, Phil. They are about to discuss her new client, Graham, aged 26, who was referred by his GP for low mood.
  
  Amelia: I’m finding it hard to engage with him.
  
  Phil waited, he saw no point in responding to what Amelia had typed.
  
  Amelia: I don’t know what it is. I’ve worked with depressed patients, people with clinical depression who have a really flat mood. And it’s like I can empathise with that flatness, find words to convey what I am experiencing and make some kind of connection, but with Graham it’s different.
  
  Phil wanted to show he had heard what Amelia was saying and to open up the exploration.
  
  Phil: So the difficulty you are experiencing engaging with Graham has a different tone to what you have experienced before? 
  
  It seemed important to Phil to hold Amelia on this contrast as she was finding the actual experience difficult to put into words. There was a pause before Amelia’s response appeared.
  
  Amelia: Just feeling my way into what you just said. Trying to get a sense of the difference. Not sure about tone. It’s really hard to get hold of…
  
  Phil: OK, a sense of something there but hard to get hold of, not a tone exactly, but hard to define?
  
  Amelia: No, it’s before defining. It’s like I can’t define it because I can’t get hold of it.
  
  Phil: OK, it’s about not being able to get hold of it
  
  Another pause
  
  Amelia: Almost like it’s not there.
  
  Phil was unsure what Amelia meant. What was the ‘it’ she was referring to?
  
  Phil: It’s not there?
  
  Amelia: Like I’m trying to get hold of something that’s not there to get hold of.
  
  Phil felt a need to bring the exploration visibly back into the context of Graham. He was beginning to feel that Graham was missing from the exploration in some strange way and felt he needed to voice this. He wasn’t sure why; it just felt important.
  
  Phil: So there is something about Graham, or your experience of Graham, that gives you a sense that something’s not there; that there's something you can't get hold of – like something's missing?
  
  Amelia: We’re missing, I mean I’m missing, I’m missing Graham. I’m not connecting with him.
  
  There was a pause before Amelia continued.
  
  Amelia: I’m not getting anything back.
  
  Phil was struck by what Amelia had typed, it stood out, ‘not getting anything back’.
  
  Phil: Like something that’s usually there, but with Graham it’s missing, something he’s not giving back to you?
  
  Amelia: I want to say it’s not a something, it’s, hmm, this is going to sound strange, but it’s like he’s … I don’t know how to say it.
  
  Phil: Something that’s different and hard to put into words.
  
  Amelia: It’s more like I’m not connecting with him because he’s not there and so he can’t give something back. He is there, he’s sitting in front of me, but...
  
  Phil felt himself take a deep breath. The thought had come into his mind that maybe there was an element of autistic spectrum disorder (ASD) behind how Graham was being experienced by Amelia. He put the thought aside, to come back to later, so that he could explore with Amelia what she was experiencing. He knew from experience how giving something a name, a diagnosis, may block the exploration of what was being experienced, of the actual relational content, which is such an important feature of relational counselling.

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  Points for reflection
  1. Is Phil right not to voice his thoughts about possible ASD at this point in the supervision, and why?
  
  2. How would your theoretical approach begin to make sense of what is being experienced and communicated by Amelia in the supervision session?
  
  3. Can giving an experience or a process a diagnostic name obstruct a therapeutic exploration in the way it is occurring in this supervision session?
  
  4. When Phil brought the focus back into the context of Graham he introduced the notion of something being missing, which led to Amelia recognising she was not getting something back. Was this facilitative supervision, or just fortunate? How much does your theoretical approach support, or account for, how acting on an inner urge to say something that arises within a supervisor (or a therapist) that proves to be facilitative?
  
  5. What other explanations come to mind to make sense of what Amelia is communicating about her experience of working with Graham?

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  To respond to the points for reflection please email niki.lawrence@bacp.co.uk
  
  Richard Bryant-Jefferies has written a number of books on counselling and alcohol use themes, in particular using fictitious dialogue to allow the reader to engage with characters and processes within the counselling room. He has been a counsellor and supervisor working in the NHS and in private practice. Visit www.richardbj.co.uk 

• Further reading:
  BACP Information Sheet ‘Recognising AS and its implication for therapy (G9). BACP members can access the full information sheet by logging into www.bacp.co.uk. 

Non-members of BACP can purchase online at the BACP bookstore