I have a confession to make: I’m a morning lark. What’s more, I’m an early afternoon lark too: my get-up-and-go doesn’t run out until 3pm, and then I coast on my momentum until 5pm when it’s time to make dinner.

That means that for most of my therapy sessions, I’ve got heaps of pep, which is great for clients who can feed off that energy… and less so for those who are slowed down by their health.

Thankfully (and that’s a strange word to use in this context; bear with me and I’ll explain), despite all this I work pretty well with clients with long term illnesses – often, invisible illnesses. I put that down to my history: my mother had and autoimmune condition called psoriatic arthritis, which was invisible most of the time but meant she often needed to be gentle with herself. She also wasn’t the most peaceful of souls, so a lot of responsibility fell on my shoulders to be aware of her physical and emotional state, and to help keep the house calm.

A few years after I left home, my partner of the time developed migraines. While we gradually learned his triggers, it didn’t stop them from occurring. Migraines are also invisible, so I found myself leaning into my old skill-set of being aware of his rough days.

Fast forward a few years, and I’ve made a friend with several long-term conditions including chronic fatigue, and worked with two clients recovering from strokes. This whole invisible illness thing does seem to keep coming up in my life.

This has changed some of my working habits. When clients of mine become non-verbal (which happens from time to time during stroke recovery), we may spend the time in comfortable silence until they feel free to talk again, or we may switch to Zoom sessions where we can use the chat box. For my stroke clients, relearning how to talk means that we may switch between the chat box and actual speech. Using the chat box also helps because stroke recovery clients work so hard to speak that they can struggle to be in the moment and remember what was said. In this way, using the chat box can act like their journal. I save and send the chat log after the session on request.

Other clients may need to keep moving so that their joints don’t seize up; if this is an issue I may suggest an easy-going, flat walk around Bristol Harbourside. Others may want to switch between walking and sitting; every day can be different and require a different approach.

Another aspect of all this is the extra time taken up by processing the illness itself. Sessions can often involve a lot of talking about how your week’s been while coping with your condition, rather than unearthing the valuable insights to be discovered in the ‘archaeological site’ of your life (phrasing stolen from a client who had a way with words!). That’s fine; sometimes, just processing how hard things have been is what you might need. For others, it may not be, and you may ask at the start of sessions for my support in halting the conversation to redirect it if you think you might mull over your condition more than is healthy.

If you are suffering particularly acutely on the day of your therapy session, you may need to cancel it on the day. This is important too: therapy is supposed to help you feel supported and more able to manage your life; it shouldn’t become an extra burden. If getting up, travelllng to and from a session, and spending the best of part of an hour talking is too much, then in my opinion, you shouldn’t be penalised for that. It’s worth discussing this with your therapist before you start sessions so that you and they can agree together, what will happen if you cancel at short notice.

Therapy can be very intuitive and creative, and sometimes, finding ways to work around a medical condition requires a spot of creative thinking. It’s okay to expect a therapist who has available space to discuss your needs with you, and how they can be met.

Photo by Jacob Yavin on Pexels.