The Benefits of Counselling (Part One)
QENDO support worker and counsellor Amanda Grogan recently gave a presentation as part of QENDO’s At Home series about the benefits of counselling, with mental health an essential component of any chronic illness management plan. With us announcing our Counselling services this week, this three part blog series with Amanda will discuss in depth the role that counselling can have if you’ve been diagnosed with a chronic illness like endometriosis, adenomyosis, PCOS and/or infertility; covering the who, why, what, where and when. In part one, we'll cover the who and why: who are counsellors, and how do they differ from other mental health workers? And why might you see a counsellor, especially if you’re a member of the chronic illness community?
First, a note about mental health. These days this can often be used as a substitute for mental health conditions or mental illness – like depression, anxiety, schizophrenia. According to the World Health Organization, mental health is “a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”. So mental health is about wellness as opposed to illness. It’s important to remember that mental health is complex. The fact that someone is not experiencing a mental health condition doesn’t necessarily mean their mental health is flourishing. Likewise, it’s possible to be diagnosed with a mental health condition or illness while feeling well in many aspects of life.
Ultimately, mental health is about being cognitively, emotionally and socially healthy – the way we think, feel and develop relationships - and not merely the absence of a mental health condition.
Everyone has mental health – when we are talking about endometriosis, adenomyosis, pelvic pain and other illnesses there is also a higher prevalence of mental illness – which I will touch on later.
WHO
Our idea of what a psychologist or counsellor is often comes from the media and entertainment – and even when asking those in the industry itself there can be lots of varied responses. To give you a generalized breakdown:
PSYCHOLOGIST
In Australia, this is a regulated profession. That means you can’t advertise yourself as a psychologist without meeting certain criteria, similar to a doctor or an engineer, and adhering to their industry’s ethics. Psychologists must be registered with the psychology board of Australia (PsyBA) and listed with the Australian Health Practitioner Regulation Agency (AHPRA). Psychologists have six years of university training and supervised experience – they also have to meet requirements every year for ongoing development, training and learning. Psychologists may work in research or for an organization, or they may work with individual clients in a therapy session. Psychologists use the medical model or clinical approach in their work with people – often looking for a diagnosis of mental illness and promoting researched treatment methods.
They can be a great asset if you have or suspect you have a mental health condition such as depression, anxiety, bipolar, eating disorder etc. and want to confirm that illness. They can also help you work on strategies – just as a psychiatrist and counsellor does, which we will see soon. Much of the time, psychologists will work long-term with a client, concentrating on restructuring the personality, deep insight and bringing about profound change. This is where the entertainment image comes from of a client on a couch in their therapist’s office, talking about their childhood!
PSYCHIATRIST
A psychiatrist has started their training as a medical doctor – so they have at least 11 years training and experience in medicine. Once they graduate as a doctor they then complete additional study to become a psychiatrist. This is why a psychiatrist can diagnose a mental health condition or illness, but can also prescribe medication to manage it. They can also admit you to hospital if need be. A psychologist cannot do either of those two things (only diagnose), which is why generally speaking, a psychiatrist will see clients with more debilitating or quick onset mental illnesses. As well as talk therapy a psychiatrist can also use practical advice, medication or brain stimulation therapies (like electroconvulsive therapy).
COUNSELLOR
In Australia, a counsellor is not a protected term or profession – that means that absolutely anyone can call themselves a counsellor, even if they have done literally no study in the field. To counter this, there is the ACA (Australian Counselling Association) and PACFA (Psychotherapy and Counsellors Federation of Australia). For someone to be a member of either of these organizations, they need to meet certain requirements. This includes a list of appropriate study, ongoing professional development, working with a supervisor and following their code of ethics. Because there are no laws around counselling – like there is with psychologists, doctors and nurses, it is really important that when choosing a counsellor you check they are registered with ACA or PACFA. That way you know there is a professional body that is vetting and regulating your counsellor.
In general a counsellor uses the wellness model in approaching clients’ therapy, using the client’s strengths to promote behavioural and life changes. Many people think of counselling as short term – someone who can help you through a difficult stage or situation; however you can also work with a counsellor long term. Counsellors are often trained in many different modalities such as talk therapy, play therapy, somatic therapy, cognitive behavioural therapy (CBT), person-centered and many more. They often specialize in one particular area where their knowledge and methods are required – for example grief and bereavement counselling, marriage counselling, addiction counselling.
When deciding WHO you should see – all three of these professionals can help you, so there is no wrong answer! There are some differences but more so there are similarities – a professional who is empathetic, kind, caring who is there to help you with your mental health, a mental illness or an issue in your life. An effective counsellor will have qualities such as:
A good listener
Patient
Research oriented
Encouraging
Authentic
Non-judgmental
Discreet
Self aware
Empathetic
Compassionate
At the end of the day, it comes down more to the individual person – you need to feel connected to your counsellor and know they are trained in your unique needs.
WHY
“The most common reasons people see counsellors relate either to relationships or to developmental life changes. People also seek counselling for emotional and psychological trauma, physical illness or injury and loss” (Geldard, D. & Geldard, K., 2012).
There are 5 major reasons listed here, let’s have a look at those.
Relationships - difficulty establishing or maintaining relationships, relationship issues with a partner, navigating dating, breaking up with a partner or negotiating co-parenting - these are all reasons why someone may seek a counsellor. Family and friend relationships also would come under this heading as would other relationships such as with employers, colleagues, community members etc.
Developmental life changes – refer to stages of development such as childhood, adolescence, young adult, parenthood, older age.
Emotional and Psychological Trauma – Trauma is a single or series of events that threaten your sense of wellbeing (or your life) and how safe you are. It’s a literal life changing event. Some examples could be physical or sexual assault or abuse, an accident, a natural disaster, suddenly loosing a loved one, domestic violence, an illness, daily discrimination and fighting or living in war. It’s not the event that causes the trauma but your reaction to it – which means two people could be in the exact same car accident and one person experience trauma whilst the other does not. There’s no wrong or right way to experience trauma - this isn’t a reflection on you, it’s part of the complicated way our minds work. Trauma left untreated or that continues to get worse can turn into PTSD or CPTSD – post traumatic stress disorder or complex post traumatic stress disorder.
Physical illness or injury – We will touch on some unique aspects of illness for our QENDO community in a moment, but seeking a counsellor for physical illness or injury is a common reason. A major accident or injury can change your world, as can a major illness like cancer, diabetes or AIDS.
Loss – particularly in the Western world, we don’t always have a healthy relationship with grief and loss. Grief is not only experienced after the death of a loved one, but also loosing a relationship or job, loosing a home, loosing an important role in our life, divorce or any major emotional loss.
One important note, you don’t always have to be having an active problem or issue you are dealing with – you can work with a counsellor for self development and to gain extra insight into yourself. They can help provide a framework and experience for self development; similar to how you might work with a trainer at the gym.
Below I’ve included some unique reasons why someone with endometriosis, adenomyosis, PCOS, pelvic pain or infertility may seek counselling:
Pre diagnosis We know on average it can take between 7 and 12 years to get diagnosed with endometriosis – so that pre-diagnosis stage can be really frustrating and scary, particularly if your support systems or GP/gynaecologist are not understanding.
New diagnosis It can be a grieving process to loose the life you once had or future you planned. New diagnosis can bring up many different emotions and thoughts including relief.
Preparing for treatment + making decisions about your treatment Having a sounding board who is not emotionally invested like your family or friends may be, is really beneficial when making decisions about your treatment. A counsellor can ask lots of thoughtful questions and help you work through emotions like anxiety or fear.
Impact on relationships, social life + career
Infertility
Hysterectomy
Miscarriage
Coping strategies for stress + flare ups A counsellor can help you develop a strategy for flare ups to help minimize the impact on your emotional and mental health, and potentially therefore the symptoms and flare itself. They can teach you coping strategies such as mindfulness that can reduce stress.
Effective communication + how to self advocate Counsellors can educate you on boundaries and help you work on putting these in places with all different relationships in your life. They can work with you on communication skills so you can express and advocate for yourself and your needs.
Surgery Anxiety We’ve touched on a counsellor assisting you making that plan for the right treatment, but even if you have chosen surgery willingly, it doesn’t mean it isn’t scary and bring up feelings of anxiousness.
Coping with unsuccessful treatment and continued pain/symptoms
Pain education, management and strategies
Talking about how your family friends and colleagues behave react or support
Sexual Intimacy + Changes Being in pain can effect your sexual intimacy with yourself or partner. Often pelvic pain can make penetration difficult, painful or impossible. A counsellor can help you expand your idea of what sex is, to include many forms of non-penetration. They can assist you with those emotions and thoughts around changing intimacy and connection
Illness Uncertainty Particularly with endometriosis, adenomyosis and chronic illnesses – they can be every changing. You may be “fine” for years, then have a short period of flare up, then okay again, then a long flare up – it might even change for you on a shorter timeline, with each day or even each hour of the day being unpredictable. This uncertainty can be very stressful
The last unique reason, I want to touch on, for a person in the QENDO community to seek counselling may be Medical Trauma + PTSD. We spoke earlier about what trauma is - a single or series of events that threaten your sense of wellbeing (or your life) and how safe you are. And how if left untreated this can turn into PTSD.
Below is an abstract from a psychological article with research about medical trauma and PTSD.
“[PTSD is] an anxiety disorder initiated by an exposure to a discrete traumatic event that has generally occurred in the past ... and is characterized by symptoms such as re-experiencing, cognitive or behavioral avoidance of reminders of the event, and physiological hyperarousal"(Edmondson, 2014).
PTSD produces neurobiological alterations — including higher inflammation levels — that negatively affect health. PTSD also can affect adherence to medical treatment, as people who use avoidance tactics to manage PTSD symptoms are less likely to take their medication, implement lifestyle changes, and see their doctors for follow-up visits.
Most traumas come from the external environment: a natural disaster, an attacker, a war. Medical trauma comes from within. Our bodies are the source of danger, and, as such, it can seem that a safe haven is not available to us.
Shock, disbelief, terror, heightened anxiety about the future, and disillusionment in the medical establishment are prevalent. Perhaps most notable is the changed understanding of our own vulnerability to pain, suffering and death. Our previous worldview — in which the world and our place in it were things we understood — has been shattered by illness, and our perception of safety has been altered irrevocably.
Additionally, intense medical situations can further exacerbate an existing condition or trigger an acute episode. Anxiety disorders, depression, bipolar disorder, schizophrenia, and personality disorders may all flare up during the post-operative period.” (Katie Willard Virant, 2019) https://www.psychologytoday.com/au/blog/chronically-me/201905/chronic-illness-and-trauma-disorders
As well as Medical Trauma and PTSD, there are some other mental illnesses that we have to consider when we have or know someone who has chronic pain or a chronic illness.
PubMed is a database that contains more than 30 million citations and abstracts of biomedical literature. If you take a quick look you can see over 250 results of studies that show links and research between depression and endometriosis. Over 142 on research between endo and anxiety. Over 709 when I search for pelvic pain and depression. So there is a lot of reading and research you can do there, and the link between mental illness and chronic pain is very well known.
Some examples “Endometriosis patients with pelvic pain had poorer quality of life and mental health as compared with those with asymptomatic endometriosis”
“Endometriosis was associated with an elevated likelihood of developing depression and anxiety disorders”
“It has been demonstrated that high levels of anxiety and depression can amplify the severity of pain”.
It’s important for everyone to look after their mental health and this is even more so as we can see, for those with mental illness or chronic illness.
Stay connected to our QENDO socials to see when Part 2 is released where we discuss the ‘WHAT’ section on Benefits of Counselling.
If you’d like to learn more about our counselling services, or book an initial appointment with Amanda, you can do so here.
The materials available on or through the website qendo.org.au [‘QENDO’] are an information source only. Information provided by QENDO does not constitute medical advice and should not be relied upon to diagnose or treat any medical condition.To the maximum extent permitted by law, all contributors of QENDO make no statement, representation, or warranty about the quality, accuracy, context, completeness, availability or suitability for any purpose of, and you should not rely on, any materials available on or through the website qendo.org.au. QENDO disclaims, to the maximum extent permitted by law, all responsibility and all liability (including without limitation, liability in negligence) for all expenses, losses, damages and costs you or any other person might incur for any reason including as a result of the materials available on or through this website being in any way inaccurate, out of context, incomplete, unavailable, not up to date or unsuitable for any purpose.
