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Monday, 13 April 2015

Working with Occupational Stress

I haven’t checked them all (of course) but I’d say every decent Hypnotherapy Practitioner course covers working with stress. Whoever you train with, or wherever you are in the world, it’s a staple of many practices and often underlies or interacts with other presenting issues as well. Learning about stress is the Hypnotherapist's equivalent of learning their ABCs. Of course the basics are usually pretty much the same: for example, no matter what the cause of the stress the biology doesn’t change. But occupational (work related) stress has elements that may not arise in stress that comes from other sources. It's worth knowing about them, so here are a few basic guidelines.

Work stress and the law

Here in the UK occupational stress is covered by Health and Safety regulations. Employers owe their employees a Duty of Care similar to the one therapists owe to their clients. Broadly, they are supposed to protect employees from 'avoidable' stress. This means you can’t sue an employer for the stress of being around kids all day if you are a teacher, it’s an unavoidable part of the job! But you might be able to sue if, say, the building was falling down and you became ill due to the stress of dodging  falling pieces of masonry, or if your colleagues harassed you because of your race, gender or religion.

It's worth finding out from any client who presents with work related stress whether there is a court case pending, or if there is likely to be one in the future. If there is, ask them to check with their legal team if there are any implications to them working with you before you go ahead.

The impossibility of change

It’s a classic axiom that clients may not be able to change their situation, but they can always change their own response to it. This is particularly true of occupational stress issues, where significant change may be difficult or even impossible (at least in the short term).

If your client's stress is due to a work culture which allows bullying and harassment, low pay and long hours, constantly increasing workload, or aggressive and difficult customers this won't be altered by one employee seeking help from a therapist. Indeed, a change of employer (or even career) may be the best option but this is likely to be a long term project.

Armouring your client emotionally, and identifying appropriate coping strategies is a useful approach while this happens. Consider improving workplace skills as well as those which help with stress; anger management, communication skills, time management and so on.

Referrals for occupational stress

You may get referrals from an employer, and in my experience this is often for someone who is already suffering quite a bit of stress, and may have been off sick for some time.
The main difficulties (apart from the fact that you'll have to invoice them to be paid, rather than collect the money at the sessions as usual) are that 
  • there may be motivational issues if the client has only agreed to see you under duress, or the threat of losing their job
  • the balance of confidentiality can be different from that of a self-referring client
  • the employer may have expectations about timescale or budget
The first of these can be the trickiest. Many hypnotherapists, myself included, don’t generally accept clients via calls from friends, relatives and so on because making that first contact is part of the therapy. It means the client accepts that they need help, and they are motivated enough to look for it.

If an employer sends someone for therapy, especially if they have not been consulted or given a choice, they can be understandably resentful; many feel that they are being scape-goated, or that the employer is just trying to 'tick boxes'. Even if you secretly agree, it will have an impact on the results of the therapy if your client is actively resistant, or even just uncooperative.

My advice is to start with an informal meeting with the client, before you agree with the employer to take them on. Work on reframing the situation so the client appreciates that they can be benefited by therapy, despite their perceptions of their employer's motives. If you can’t do this, and feel therapy is unlikely to succeed, my advice is stop there. 

Moving on to confidentiality, the employer is paying you and they will probably expect some level of feedback on the sessions. On the other hand, your client is unlikely to share much information if they feel it will all get back to their employer. Agree with both parties how this will be handled before commencing therapy. My own compromise is usually to send an email to the employer after each session confirming that the employee attended and when the next session is. I include a couple of sentences to say what we covered without giving away any personal information, for example 'today we looked at strategies for coping with anger'.

Finally, we all know that 'how many sessions will I need?' can be the hardest question to answer. Some clients progress more quickly than others. Some simply need to move on and others have deep underlying issues that need to be addressed before moving on is possible.

Unfortunately most employers have a limit on the time or money they can spend on one employee and you may be asked to state in advance exactly how many sessions you will need. This is best done after the informal meeting we suggested above, when at least you will have the client's own view of their situation. You'll probably have to work in a more linear way than usual, since you'll not have time to follow up on any unrelated issues that are identified. I do advise the client that this is something they could consider following up, either with me or someone else, but as they'd have to pay for this themselves you can't insist.

Where to go from here?

Even if you don’t see yourself signing multi-million pound stress management contracts with world-wide companies, occupational stress is a rewarding and fascinating area to work in. If you are interested in knowing more I have a CPD course on the subject, which covers working with individuals and employers, and you'll find the details here. I'll also write some tips on offering seminars to employers for this magazine, later this year.

But in the meantime, if you have your own tips about working with work related stress, or any questions about moving into this area, please use the comment box below or email me.

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Author: is Senior Tutor At Yorkshire Hypnotherapy Training, which offers multi accredited hypnotherapy practitioner training in Wakefield and York, along with taster days and foundation levels. Debbie has written a chapter on working with IBS in The Hypnotherapy Handbook, aimed at students and newly qualified hypnotherapists and also offers supervision and continuous professional development (CPD) for those in practice. Please contact Debbie to find out more.

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