‘Working with a Bulimic Client’
by Richard Bryant-Jefferies
The article, ‘Working with a Bulimic Client’ shows Ginny, a person-centred counsellor, reflecting on her concerns for a client during her supervision. She is reflecting on her first session with a client who has bulimia, focusing on the issue of passing on information. Ginny was concerned with the physical implications of bulimia due to the client complaining of a bad throat. Knowing the dangers of bulimia, Ginny was faced with the conundrum of whether to pass this knowledge on to her client or respect the client’s choices and maintain her focus on providing empathy and unconditional positive regard (UPR). This also raised ethical implications in terms of the client’s health and well-being.
The article was extremely thought-provoking and it was interesting to witness the counsellor’s self-knowledge and understanding evolve throughout her supervision. By the end of supervision, Ginny realised that this was less about her client and more about her. “I’m not trusting her, am I?” Ginny reflects. “I’m not trusting her to do what I think she needs to do.” This realisation illustrated that by focusing on the physical implications of bulimia rather than offering unconditional positive regard towards her client’s choice of behaviour, the agenda had become the counsellor’s as opposed to the client’s. She was focusing on what she felt the client needed as opposed to what the client felt she needed.
Ginny later realises “…if I had stayed with her talking about how intense the discomfort was becoming in her throat, she may well have realised for herself that she needed to seek medical advice.” This realisation provides insight into the power of unconditional positive regard and empathy combined. It has the potential to empower the client to be the agent of their own lives. As soon as a counsellor attempts to influence a client’s behaviour, the client is disempowered. Even if the client does follow the counsellor’s direction, they are not provided with a sense of personal control and achievement, which could even lead to a dependency on the counsellor.
The counsellor’s need to inform the client of the dangers of bulimia appears to have come from the fact that “I see myself as a health professional.” This automatically creates a hierarchy of expertise, which does not complement the person-centred approach to counselling where counsellor and client are equal.
The article was very accessible, written in the form of a supervision session. I enjoyed reading the conversation between the counsellor and her supervisor, as it showed just how much a person can grow by reflecting on their own motivations for taking a specific course of action with a client.
The article has helped me in a number of ways. It has highlighted the value of empathy and unconditional positive regard and how focusing on providing these as opposed to advice can empower clients. It has also demonstrated that in order to be a congruent counsellor I need to remove my ‘health professional hat.’ I may have studied and gained qualifications in health, but I am not the expert in a client’s life choices – they are.
I am there to listen and provide the necessary conditions of empathy, congruence, and unconditional positive regard to facilitate the client’s own personal journey of self-discovery.