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Are Clients Feeling Pressure to Answer My Calls?

If clients have become slower to answer session calls or engage in dialogue during the pandemic, how might we respond? Drawing on her work with resettled refugees, Jude Boyles reflects on the importance of continuing to offer that weekly call – while finding ways to explore how individual clients experience our persistence.

In early February 21, Sheffield welcomed a group of Syrian refugee families from Turkey. This was our first resettlement since the beginning of 2020, before the start of the pandemic. The families are quarantined, but we will visit them online in the coming weeks.

A few weeks ago, following a video session with a young Syrian refugee and mother, I wondered whether my attempts to reach out to her could be experienced as oppressive rather than caring or encouraging. I had called for our scheduled session a few times before she responded. She had a blanket wrapped around her and her voice was quiet and flat. She lives alone and is home schooling her two children when she has little English herself. She has a chronic pain condition. The session started slowly. She sighed a lot and seemed distant.

At various times during the call, I felt anxious that my approach might feel overly energetic rather than warm and encouraging. However, by the end of the session she had lifted visibly and was reminding herself to do the things that kept her going during this relentless and isolating time.

Following our session, I noticed that a few clients were taking several minutes to pick up, or needed a reminder by text to log on to Zoom. Were my calls being experienced as a pressure? Did clients feel obliged to answer?

I began to find ways of asking…

The range of responses was interesting and mostly reassuring. One said, “I had actually forgotten about the appointment as I am losing track of the days but when I saw it was you, I was shooing everyone out of the room so I could be alone”. Another said that she was low and hadn’t wanted to talk to anyone but picked up the phone because I kept ringing. She reflected that she knew I cared about her and wasn’t going to give up on her just because she was having a bad day.

I’m sure that many therapists might have concerns about reaching out in this way, but these are different times. During these unusual times, bringing energy and commitment when clients are depleted can offer hope and connection. When working with refugee clients who are new to talking therapies, it is especially important to ensure we continue to offer a weekly therapy call, even when we sense our client is not yet convinced it will be a helpful resource. It can take a few sessions to fully understand what therapy is and why it helps. Persevering to allow time for engagement is vital.

The pandemic has inevitably exposed health inequalities faced by black and ethnic minority groups. Therapists within the refugee sector have long been concerned about the multiple barriers our clients face in accessing therapeutic and mental health services that can easily exclude them. Many of us have felt frustrated at how quickly refugees are discharged from services because they haven’t engaged. We frequently hear from our clients that they have been denied a service on the grounds that they are “unable to use therapy” or have only presented “with social problems”.

My team’s weekly calls to clients can be very important, especially for those living in poverty with busy family homes and painful histories. Sometimes it won’t be easy to pick up the phone and our clients might not always know how to start the conversation when they are low and lost.

Our role is to be curious and help them use the call. As the pandemic continues, some sessions will not always be dynamic therapeutic dialogues. But there will be connection, care and reassurance. In this moment, this can be the most helpful intervention we can make.

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Jude Boyles

Jude is the Manager of a therapy service for the Refugee Council, working with Syrian refugees resettled via the Vulnerable Person’s Resettlement Programme (VPRS). Jude edited Psychological Therapies for Survivors of Torture for PCCS Books and published Working with Interpreters in Psychological Therapy with Routledge. She specialises in working with refugee survivors of torture/war and human rights abuses, including gender-based abuse.

In 2003, Jude established the first Freedom from Torture (FFT) rehabilitation centre outside of FFT’s headquarters in London, and managed the service for 14 years. As part of this role, she provided clinical and management supervision to therapists and managers working in the refugee field in the region and carried a caseload of torture survivors. Jude has worked as a national trainer in the field of therapy with refugee survivors of torture for 18 years but has also trained extensively in the field of domestic violence and child sexual abuse for 23 years.

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