Why I . . . see a counsellorBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m745 (Published 09 March 2020) Cite this as: BMJ 2020;368:m745
“I’ve come to the conclusion that counselling is a self-indulgence that everyone should have,” says inner city GP Austin O’Carroll, who has seen a counsellor on and off for a number of years.
In 1997 he took over a practice in a deprived area of Dublin and soon felt under immense pressure. “It was just me and a receptionist and I was dealing with a lot of complex social and medical problems,” he says. “There were some nights when I would take something to help me sleep and I realised it wasn’t a good way of dealing with the stress.”
O’Carroll decided to see a counsellor and says of his first session: “I spent most of the time talking about why I hated house calls. Then, after about 45 minutes, I remember pausing and thinking, ‘I really love house calls, but I’m tired, I don’t have lunch, and there is no limit on the number of calls I attend.’ It was the lack of power that was causing my antipathy to those calls and so I went back and restructured the way I worked.”
He says that counselling gives him the space to deal with his feelings and the way in which he works with patients. “I’ve formed the opinion that GPs working in areas of great deprivation sometimes become the type of doctors who are in survival mode,” he says.
“Counselling helps me avoid going down that route. I also use it for complex patient interactions. My counsellor isn’t a medical or social expert, but by asking appropriate questions helps me explore how I can deal with relationships with patients more positively.”
O’Carroll says counselling has been crucial in avoiding burnout. “There have been times when I’ve gone into work and felt fully empathetic and times when I haven’t felt it at all and I just go through the motions,” he says.
“Patients pick up on that really quickly. The thing that makes you go into general practice is the sense of being able to feel. I started to re-engage with counselling two years ago to tackle my feelings of being overworked and overloaded. It’s helped me by enabling me to vent, to rationalise things, to create a proper balance for work life and home life, and to explore where my career goes next.”
O’Carroll adds that there is, to an extent, a stigma attached to counselling. “It can be seen as weak, as something for people with problems. My perspective is that everyone has problems—it’s part of life and counselling is a way of managing that. I tell everyone that I find it extremely useful and I know other people who do, too.”
How to make the change
Choosing the right counsellor for you is crucial. O’Carroll says he wanted someone empathetic, but who would also challenge his thinking and not allow him “to float along.” Ask for recommendations and have an initial session with one or two and then select the person you feel you can work with best
Decide what sort of counselling you want. O’Carroll recommends going for something generic rather than taking a Freudian approach, for example
How much time do you want to commit? O’Carroll goes to monthly sessions but some people opt to go weekly
Work out whether you want one-to-one sessions or if you would prefer to be part of a group