Annette: There’s an issue I need to discuss with you. It’s about a client I’ve mentioned before – Patience, my Nigerian client, who was referred for low mood.

Barry recalled the previous supervision session, when Annette had mentioned Patience’s religious background; how important her Christian beliefs were for her and the strength she found from attending her local evangelical church. He held back from introducing a particular focus to the supervision session.

Barry: Yes, you mentioned her last time.

Annette: In our last session Patience was talking more about her faith and how it was important to her, but she also talked about how important I have become, and how much she values and appreciates my listening to her and helping her.

Barry felt himself smile. He wondered how Annette had felt about that, but noted this thought as his own human curiosity.

Barry: Sounds like you have become really important to her.

Annette: I felt quite humbled, I mean, I guess it’s me but, you know, she is so, I don’t know, I want to say ‘African’ in how she is, and that’s such a stereotype. But it’s how she looks and talks and everything. Hearing her say that, as a white woman, I felt a mix of honoured and humbled.

Barry decided to empathise and hold Annette with what she had just told him as it felt important to acknowledge. It had clearly affected Annette.

Barry: Hearing Patience value you like that, and with the differences between you, felt really honouring and humbling.

Annette: I thanked her, and said that I really appreciated her and what she had just said to me.

Barry: Sounds important to have acknowledged this.

Annette: It was. But then just towards the end of the session, she asked me if I’d pray for her.

Suddenly, Barry felt his concentration feel more focused. He empathised again, not wishing to direct Annette towards her reaction, but wanting to leave it open, as he had no idea what was coming next. He recalled that Annette had told him during a previous supervision session that she did not have a faith herself.

Barry: She asked you to pray for her…

Annette: I felt absolutely stuck. I knew I was faltering and I could see in Patience’s expression that she was hurt by my hesitancy. I’ve said before, I don’t have a faith, not in a God as such. I don’t pray. I don’t know, I felt like something that was just so good and positive between us, had broken in some way.

Barry noted the urge to ask Annette what she had done next, but again decided to simply acknowledge the contrast in experience she was referring to.

Barry: Something felt broken in the relationship.

Annette: There wasn’t time to explore it. I said that I didn’t have a faith, but that I respected her for her faith. I meant it but it all felt rather hollow. Patience smiled and shrugged a little, but her eye contact changed and, I don’t know, I really don’t know…

Points for reflection

1. What was your first reaction to this situation? Are you noting any particular empathy towards Annette, or to Patience?
2.  Do Barry’s responses seem facilitative, or should he have more directly expressed his thoughts and reactions?
3.What would you expect Annette to be exploring in this supervision session?
4. Annette describes her model of practice as integrative. How would your theoretical model of practice inform your response if you were a) Barry, b) Annette?
5. What should Annette consider saying at the start of her next session with Patience?
6. If Patience does not attend the next session, and does not contact Annette, how would you respond?

Responses to points for reflection 
by Caro Bailey

1. My initial response was a lack of surprise. My overriding feeling was one of curiosity and rather more empathy towards Patience than Annette. I was wondering for example, when Patience first talked about the importance of her Christian beliefs, whether Annette had chosen to disclose that she did not have a similar faith. At the same time I would like her to have enquired of Patience whether her own lack of similar faith might get in the way of them being able to work together. I imagine Patience may have felt a familiar sense of being let down, of hopes not being realised.

2. I believe there is an ethical issue here based on fundamental differences in belief between counsellor and client, which should have been raised by Annette when Patience first mentioned her faith. Not doing so has been assumptive on both Barry and Annette’s part – further investigation might have yielded other options for Patience. For even if the surgery could not offer alternative counsellors, Patience could have been offered the choice which might lie elsewhere. I would have preferred a little more openness and exploration of difference from Barry about what was going on for him while Annette talked of the situation.

3. I would expect Annette to be exploring difference, particularly around those of faith and belief and how she responds to this when it occurs in session. I think it is also useful to consider what Annette’s default positions might be when ‘she’s caught on the hop’ and, in this particular context whether it might be a useful reminder about what she raises in her initial contact with clients.

4.I believe that regardless of therapeutic modality, the most important mode of practice is to be humane and kind. Matters of belief and faith are hugely important, touching deeply on our sense of self. As an integrative practitioner my response to Barry would be to encourage him to help Annette be as congruent as she can be in this situation. To help her consider how she might acknowledge the importance of Patience’s request, while stating that although she is unable to carry this out, Patience’s wellbeing remains in her heart. My response to Annette would be to consider what she might be able to offer that is true to herself, while acknowledging her own perspective.

5. I hope Annette will bring what she was left with at the end of the last session: her sense that Patience felt both let down and disappointed and how she might have contributed to this. In this way, I would like to think this might encourage Patience to explore her expectations of other people and what she makes of this, how she manages disappointment and finds the strength to keep going; and more specifically, how she and Annette can now make best use of their remaining time together.

We are interested in your views. If you would like to respond to these points for reflection, or the responses, email niki.lawrence@bacp.co.uk