How did you get into counselling?

In my twenties I used to be involved in something called co-counselling. It’s a little known form of reciprocal support, as it’s not regulated by official bodies and is more to do with personal growth and political/social change. I had that as a background and a lot of my friends that I've known for decades are therapists , so I felt I knew that world already. I did apply for a counselling course in my early 20s, but I didn’t get in. I'd always had an incredible passion for birth that comes from my interest in politics and the position of women in society and that's why I ended up training as a midwife.

I always found it was the personal bits of midwifery that were most enjoyable and rewarding. You know, rather than the ‘have you checked everyone’s blood results’ bits. Not that blood results aren’t important! But what I really liked about midwifery was the human side of it, whether that was labour, the intensity of the birth centre, or labour ward. I was mostly community-based, so rooted in people's lives and communities. I think midwives are naturally woman-centred but the whole structure can end up being about pathways and guidelines. I wanted to find a way that my work could be purely about giving people a chance to do what they need to do.

How did you balance being a midwife and training as a counsellor?

To begin with, I did a group analysis course over 11 weekends, which was on top of working as a midwife. Then I dropped a day of midwifery to do an Advanced Diploma in Counselling through a University, and then my MA in Counselling. I never picked up that day again and I used it to do counselling. Then I dropped a second day and did half and half, and in the end, I got a perinatal counselling job and just left midwifery.

Can you tell me about the job you have at the moment?

I’m a counsellor three days a week in the same trust I used to work as a midwife . I’m situated within the antenatal clinic and I take referrals from people who are either pregnant, been pregnant or have had a baby, anything from pregnancy loss, having a child in the Neonatal Unit, to birth issues. I might see people who had a traumatic birth, either postnatally or when they are pregnant again. And I see people with more general issues but I try to concentrate on perinatal stuff and leave other services out there for more general things. I take referrals from midwives, doctors, sometimes health visitors. Unlike midwifery, counselling doesn’t usually have an instant role at the end of the training. You have to build it slowly, perhaps do some private practice, work with different organisations, get a number of part time roles. There’s a lot of scope for doing it slowly and in a small way. By the way, another route into perinatal mental health is Health Visiting, and midwives are well placed for that role. I don’t know as much about the training, but it’s worth looking into and services are being expanded at the moment. 

How do you organise your work?

I have to juggle the needs of individual clients with the number of referrals and how big the waiting list is. Sometimes I manage to juggle it so that I don't have too long a waiting list. But I don't feel like I'm saying to people, ‘right, six sessions and then you’re out’. I mean sometimes I do offer six sessions and review it. Some people want to do a bit of counselling and they make some gains and feel okay. And they may not have the capacity in their life to do more than that, they don’t want to shake everything up or they just don’t feel psychologically safe enough to do a lot of challenging work. I think counselling can be a bit like cleaning out a really messy cupboard, overflowing with things that you haven’t looked at for years. Then when you open it, everything falls out and it’s worse for a bit before slowly sorting through it deciding what to keep, what to discard and what to put back away in a box on the top shelf. 

How do you feel about your work?

I have a lot of autonomy which is a really luxurious position to be in. I get to make decisions based on my clinical judgement. Sometimes I see someone with, say, really bad birth trauma, and I think it’ll be a complicated and a long process. But as it turns out they just need 2 or 3 sessions, or sometimes even 1 session, and it’s like something becomes unstuck and they can carry on with their life. And other times you think it’ll be a straightforward process and it turns out someone really wants to do some work or you can see their needs are complex. So I see them for longer. I work with after birth trauma, and the classic decision antenatally is whether to labour or have a planned caesarean, and that can take a while to think through. I love my job but because of the autonomy, it can be a bit lonely.

Do you feel you have enough support?

I am able to take more time with people, so unlike in midwifery, I can have a (short) waiting list. Midwifery has a culture of helping people, but if that means it’s at someone’s own expense, it can cause burnout after a few years.

I miss the craic of being part of a team. Supervision is a requirement of the British Association for Counselling and Psychotherapy (BACP), which is the biggest counselling body. They have a requirement for an hour and a half a month, so that’s what I get paid for as part of my job. But in fact, I pay for more because I have a lot of clients and some of them are complex. 

How do you cope with the potential for vicarious trauma as a counsellor?

You can't be a counsellor without supervision, because you might not realise if you were getting into something that was activating your own issues in some way, either consciously or unconsciously. You need a supervisor to untangle those things - as well as having done your own therapy.

Drawing from my midwifery experience, I know how to be with someone when they are in pain. For example, a situation when you’re with someone in labour, when they spiral into total panic? And if you can bring them down from the feeling of being out of control, they might realise that they can cope with more than they thought. It doesn’t stop it being painful, but it can become more tolerable. Sometimes as a midwife you have to connect with people, look them in the eye, touch them, or breathe with them. So you are empathically experiencing some of their distress with them . But you are not in pain like they are. Your body is not experiencing their pain. Counselling is also like that. 

Say someone is telling me about their birth trauma. When someone is feeling sad and crying, I can notice an empathic sadness in myself in a smaller way. If someone is describing a traumatic or terrifying experience, maybe a major haemorrhage when they truly thought they or their baby was going to die. If I imagine myself too vividly with them in that room and I feel too much of what they felt, there’s a risk that I could become overwhelmed in the same way that they were -and still are. That’s where the risk of secondary or vicarious trauma comes, because you’re almost feeling too much. So there are techniques that reduce too much empathy and make sure your awareness comes back into your own body. Making sure I’m engaged and grounded with my own bodily self in the present moment.

How do you work with clients who are from very different backgrounds from you?

Some of what I think has helped when I've worked with people is to acknowledge the difference including my privilege, so, ‘what's it like talking about this stuff to a white person? What does any difference between us mean?’  My background is that my parents were both immigrants, though white European immigrants so I haven’t experienced racism. But I can identify with the feeling of being an outsider in society. Asking outright can be very important ‘are you treated differently because you are black?’ Sometimes it’s the first time clients have talked about racism to a white person. Internalised trauma and internalised oppression get played out. It’s so important to be open about things like that in counselling, and to always hold onto the reality of racism in society.

Note from Ellie: In my research for this book, I didn’t find any midwife counsellors from Black or Asian backgrounds. It might be I’m looking in the wrong places but I suspect the need for excellent perinatal mental health from midwives from these backgrounds is sorely needed, not to mention psychotherapists who can counsel in different languages to support women who might not have access to these services otherwise. There are support structures around, for example ASAM, the Association of South Asian Midwives offers career coaching. There’s also the ‘Brownology’ podcast with Dr Tina Mistry. I expect and hope roles for midwives with expertise in these areas will become more common in the next 10 years.