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• This month’s dilemma
  Aimee is a young counsellor. She is keenly aware of fashion and it is important to her to dress in a fashionable and attractive way. She likes to wear low-cut tops and short skirts, or low-cut dresses in summer, and either peep-toe sandals or high heels. She wears full make-up and perfume as a matter of course.
  
  Aimee has a strong religious faith and wears a symbol of this outside her clothing. This too is important to her. However, a colleague has recently mentioned that this might be off-putting to some of her clients. Amy took this to her supervisor, who responded by saying that, in fact, her whole style of dress may be inappropriate as it may give the wrong signals. However, Aimee believes that if she changed her style of dress she would be uncomfortable and not congruent. Inevitably, she believes, this would spill over into her client work.
  
  What are the issues that Aimee should consider?

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  Julia Segal (FBACP, counsellor and trainer)
  I remember a client telling me that fishnet stockings – a normal fashion item for a brief time just then – meant ‘prostitute’ to him. It stopped me wearing them. I also had a young colleague who wore a very short skirt while counselling an older married couple, in which the woman was newly disabled. As an older married woman myself at the time, I felt my colleague was flaunting her elegant legs and that if I had been the client I would have been furious with her for doing it in front of my husband. When we discussed this, my colleague denied that there was a problem. I still think she was wrong. Sometimes I discuss with clients the fact that they have obvious disabilities and sometimes I don’t, but there does seem to be a difference between behaviour and dress which draws attention to the differences, and behaviour and dress which merges into the background and can be ignored until the client wants to raise it. I felt my colleague’s skirt increased the client’s distress; since it was not discussed or acknowledged within the session, there was no chance to help her to deal with the issues raised by it.
  
  If any of Aimee’s clients are of a different age, fashion group or religion from her, she needs to think carefully about the issues signalled by her clothing. I do understand that for some counsellors these signals are important signs of who they are, in which case a client may need to be given a choice about whether they see a counsellor of this group before they begin. Those who wear the clothing or symbols of a religious group have to be sensitive to the meaning they are signalling to the client. Perhaps Aimee is a counsellor who has to be ready to discuss whether her clothing means she is or is not sexually available – although I do not think this would enhance the counselling process and I also think it would increase the chances of her being accused of seduction by a client. Clients fall in love with us quickly enough, whatever we wear; personal experience has made me very wary of showing my knees.
  
  Aimee needs to think how her clients will see her – not just how she sees herself. Is she implicitly asking both male and female clients to ignore their own sexual responses to her body and dress during counselling? Is this what she wants to happen? Might she be making it hard for a client to be open with her? (Since telling your counsellor she is a turn-on is not generally polite.) She might think in particular about how a less attractive person might see her; and whether her clothing arouses particular envy or jealousy, which again, might or might not need to be discussed in the session.

   

   

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  William Johnson (counsellor in private practice)
  In an ideal world we could step out of our front doors either stark naked or in a full burka, and no one would bat an eyelid. We would each be perfectly attuned to our own needs for self-expression and utterly unconcerned about other people’s. Of course, in that same ideal world, no one would need counsellors. The reality is that we are all caught in the crossfire of social and self-judgment. Whilst we might strive for autonomy of expression, our role as social beings means that none of us can ever fully achieve it; and clients who come to us certainly won’t have done so.
  
  As regards Aimee’s dress choices, two words catch my attention:

   

  1. ‘Attractive’. Who is Aimee trying to attract? The client? Or is she concerned to be more attractive than her clients? If she dresses differently does she feel unattractive? Are there self-esteem issues here?
  2. ‘Comfortable’. Discomfort is one of the great guides to the self. Maybe she could experiment with spending time (a week?) dressing in ways that feel to her uncomfortable; a particularly valuable thing to try in personal therapy. Saying that she would not feel ‘comfortable’ evades the issue. She needs to translate discomfort into tangible feelings. Does she feel in pain, lonely, ashamed, angry, frightened? Dressing down for a week is not life-threatening. If it does feel life-threatening, then that would suggest a deeper malaise which needs exploring.

  I do think that using perfume is questionable. Our sense of smell has such deep and immediate effects on us. For clients to have associations either forcibly triggered or overwhelmed cannot, I think, be helpful.
  
  As for the visible symbol of Aimee’s religious beliefs, as a client, I would rather be greeted by a gigantic crucifix when I first walk in, than discover two years later that my counsellor is a fundamentalist of whatever denomination who believes that gays should be stoned to death. I would prefer that Aimee continue to display her religion outwardly, rather than hide it because it might be ‘off-putting’ for clients. They might need to be put off.
  
  On the other hand, Aimee must surely examine her religious beliefs as rigorously as she examines her mode of dress. If both stem from profound self-belief and have no impact on her judgments of others, then good luck to her. However, as I suggested earlier, I do not see how self-image – or religious belief – can be divorced from public convention. Knowing how this plays out in our lives must be the greater wisdom.
  
  Of course, however ‘neutrally’ any of us may think we present ourselves, we need to recognise that neutrality does not exist. A lesson therefore for all of us?

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  Wade Miller-Knight (person-centred counsellor in private practice and volunteer in a hospice)
  We cannot please everyone with objects associated with religions. I am open on my website about being a person of faith. This attracts some clients and deters others, as does the spiritual element in my private practice counselling room. The issue I’d suggest Aimee consider is her awareness of how her faith symbol affects clients, especially at first sessions. We can’t overcome deep prejudices such as ‘she wears a hijab, therefore I won’t be her client’. Better to be true to ourselves. The prejudiced ones will find out who we are within a few sessions and leave anyway. But if Aimee is not self-conscious about it, she may find that a discreet symbol has little effect on most clients. I’d encourage her, though, to notice responses, for example, surprised looks or curious questions – or clients’ openness about their own spiritual selves.
  
  My chief suggestion for Aimee on her clothes is to watch out for the obvious possibility that clients may be attracted or distracted towards looking at her appearance and away from their own self-change process.
  
  I’d also invite her to review her interpretation of congruence. Carl Rogers said ‘congruent or integrated in the relationship’, which invites including consideration of the client in our congruence as well as of our self. What she wears with an established client from her own subculture might on this basis be different from what she wears when meeting a new client about whom all she knows is that his name is Ahmed.

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  Sarah Prince (counsellor, psychotherapist, supervisor in NHS and private practice)
  This dilemma from my perspective is one of inappropriate self-disclosure and either a lack of regard, or unawareness of what it is to be professional. I would like to make the following points:

   

  1. The counselling profession has spent many years working towards enhancing its standing in the professional community and my own feeling is that being a counsellor is about being a professional at all times. That includes wearing appropriate clothing. The primary consideration for appropriate dress could depend on a number of factors, including the client base, setting and agency. Many organisations have a dress code that guides what is considered appropriate for their workplace, and a counselling setting is the workplace for the counsellor.
  2. Self-disclosure within a therapeutic relationship has been a matter for much research, debate and discussion. We all, unwittingly, self-disclose by our actions, dress, manners and approach, but it needs continual reflection and personal awareness for us to understand how our clients may see and experience us. Without wishing to unduly constrain the humanness of individual therapeutic styles and ourselves as conduits for therapy, a more therapeutically respectful sense of self is necessary if the client is to own the space. There are relevant issues of Aimee’s awareness with regard to equality and diversity and possible transference with this dilemma. Aimee’s overt need to display herself has the potential to intrude into the therapeutic space and distract the focus of the work.
  3. The explicit wearing of a religious symbol depends on how it is displayed, its prominence and how much attention is paid to it during sessions. Again, the context of the therapeutic environment has relevance here; for example, if the agency was connected to a religious organisation, such a symbol might be unremarkable to clients, but if such a connection is not present, it may be an unwelcome distraction.

  Aimee may choose to do some personal therapy to explore why it is so important to her to be noticeable and how she can develop other resources to support her sense of self.
  
  My overall sense of this dilemma is one of a lack of self-awareness, and understanding of the issues of transference and equality and diversity. Whilst not wishing counsellors to be a blank canvas, part of our role is to give our clients the time and space to express themselves. We best serve that by not intruding into the therapeutic paradigm with regard to our appearance, interests and beliefs.

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  Keith Anderson (psychodynamic counsellor)
  I believe that the key to the situation is not about Aimee’s appearance, but whether she can contain that appearance in the counselling session.
  
  If she projects containment and takes care not to project provocation, whether that might be sexual or religious, then I do not consider her appearance needs to be altered.
  
  She can in fact use her appearance to benefit her clients by letting them explore their reactions, be they positive or negative, to her appearance in a safe environment.
  
  Changing her appearance to suit the imagined needs of the client could well affect her work with her client, almost as much as letting the client sit in her chair. If she is uncomfortable with her appearance, she will almost certainly be uncomfortable with the client.
  
  The reaction of her colleague and her supervisor, may say more about their unease with appearance than it does about Aimee. Perhaps they express the much taught need of the counsellor to be anonymous, in both intimate personal disclosure and outward appearance.
  
  Aimee needs to reflect on her appearance, confirm that she is comfortable with it, that she can contain it and the client, and go freely forward.

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  Judith Sonnenberg (BACP accredited school counsellor)
  I imagine Aimee to be in her 20s, which can be a time for self-discovery and breaking away from dependency on parents and the discipline of educational environments. She could use this phase to reflect on her upbringing, how she coped with it or rebelled against it and what kind of behaviour this prompted, including her ways of dressing and appearance to the outside world. Whether her provocative attire might be a result of rebellion against her parents or adhesion to peer groups, she needs to think about it as she acquires a new-found maturity for doing her work.
  
  If she is religious, then modesty might be more congruent with her beliefs. In the same way modesty in front of clients gives them freedom to be who they are without the counsellor imposing too strong a message of her own, which would definitely skew the work.
  
  I agree with Aimee that we should not appear too wishy-washy. If we dress as though we don’t exist, clients might not respect us or feel that we respect them by making an effort. Nevertheless, boundaries need to be set. We don’t want to give out unwanted invitations to phantasies from our clients who are probably already confused and dismayed by their thoughts. According to Freud, most of our insecurities revolve around sexual issues. The counsellor does not need to spell out any of her own.
  
  There is no uniform for a counsellor, but I remember as a teacher that pupils noticed all my embarrassing aspects. This was humiliating and it was only my training as a counsellor that enabled me to step back and not react in anger. I don’t think it is a good idea to overtly put oneself in the firing line. Comments from clients may tell us much about themselves. Such short cuts may be dangerous strategies and could lead to resentments.
  
  It is very difficult to criticise the way people dress. It is our right to dress as we wish, but then perhaps we should not be alarmed at the emotions evoked in the people around us. Envy comes to my mind as I think of the plain, podgy, unlovable child when she observes the pretty, sexy counsellor or teacher. I can relate to that feeling and guard against being critical because of my own envy. In this case I truly think that if Aimee is serious about her career then she should beware the idea of her low-cut dress intruding into her work.

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  Jayne Phillips (integrative counsellor in private practice and former addictions counsellor for an alcohol and drug agency)
  When I read this dilemma, I felt that this was all about what Aimee wants and needs, to enable her to remain congruent and comfortable. She is a young woman, who likes to be fashionable, attractive and to celebrate her religious beliefs. Of course, there is nothing wrong with this but we live in a world where, unfortunately, judgments are made about our appearance and beliefs, thus developing a block to communication.
  
  When we, as therapists, enter the counselling room, it is an equal relationship, but when one is overpowering the other with their appearance/religious beliefs, there could be an imbalance. I asked myself, ‘How much is the therapy about the client and how much about Aimee?’ Initially, I thought that perhaps Aimee works in a setting with younger clients, who may, in fact, respond well to this sense of dress, but if a colleague has pointed out their concerns, that would suggest there is an issue.
  
  From my own experience as a female therapist, I think that it is healthy to not lose sight of who you are when working with clients. I myself wear make-up because I wear it whether I am counselling, going shopping, to the cinema or doing my gardening. However, I do tone it down in the counselling room. I never wear perfume because it is so personal, and a client can identify so much with smells. As for clothing, I do wear feminine clothes but my flesh is not on show. So Aimee could consider that there are enough options out there for her to remain fashionable and feminine without showing cleavage and legs. By doing this, she (and I) can remain congruent as the feminine therapists we are.
  
  I feel there is no place for her religious (or political) views in the therapeutic relationship and they should remain discreet, as with all the other personal information about her.
  
  Aimee will face numerous issues as she travels on her counselling journey, as we all do, no matter what our age/sex is. It is important for her to listen to feedback, particularly if it is non-judgmental. If she remains empathic and tuned in to her clients, she will be able to find a middle ground, whereby she can remain comfortable, congruent but also neutral. Aimee needs to get a balance of not only who she is but also who her various clients are.
  
  There will be plenty of occasions where she can celebrate her body and religious beliefs but not in the face of her clients.

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  Heather Dale
  Whenever I mention that I am editing these pages, I am offered a dilemma. These are so rich and varied, that I am now inviting you to send in dilemmas (suitably disguised) as well as responses to the dilemma. If you have a dilemma that you would like readers to respond to, please email Heather Dale at hjdale@gmail.com.

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  Next month’s dilemma
  Isla has been seeing Benjamin, a young man in his 20s, for a couple of months. He has come into therapy to please his parents, who are worried about his eating. As Benjamin has little money, they are paying for his therapy. Benjamin is ambivalent about therapy, although accepting that he has a problem, and saying his eating is out of control.
  
  At his last session, three weeks ago, Benjamin did not pay, saying that he would bring the money next time. However, he did not attend the next booked session and has not responded to letters. Should Isla inform his parents, asking them to pay for the missed sessions?
  
  Please keep your responses to 500 words or less. Outline your responses to the dilemma and make your thinking as transparent as possible. A small selection of answers will be published in Therapy Today, with others appearing online. Please email your responses by 28 November to Heather Dale at hjdale@gmail.com.