The Dilemma – Summer edition – the Black Eye

Welcome to the Summer 2016 edition of the dilemmas page, in which we ask for answers to fictional ‘what if’ nightmare scenarios that we might find ourselves in as psychotherapy trainees. The range of responses from our readers from within the psychotherapy world provides us with tools should anything similar ever happen to us in our personal practice.

The Black Eye


You have recently taken up a sport as part of a drive to get fit. During the match which you are involved in there is some heavy contact and you feel someone’s elbow hit your eye socket. The next day you wake up to a purple, circular bruise covering your eye. It looks more than a little suspicious, and you will be seeing clients that day.

One of your clients has had issues with anger in the past, whereas the second client has had experience of violence in their upbringing and is very bad with boundaries, always wanting to make the session about you.

How do you deal with this situation?

Celine – trainee psychotherapist says

“I would be open and honest saying I had a ‘little incident’ at sport. And would ask what did it bring-up for them. Being curious about why they would be so interested about me…what did it trigger in them ?

If they were asking about it right at the start of the session I would investigate it. There is nothing like the ‘here and now’ in psychotherapy. If they didn’t say anything I wouldn’t necessary bring it up but take note of it. If they are not saying anything but staring at it I would say: I am noticing that you are looking at … I wonder what’s going on for you…everything is an opportunity to explore…but I would let the client guide me…

Suzie, trainee psychotherapist says:

“It sounds to me like this bruise could prove to be an interesting catalyst for work with the two clients. It’s amazing how the universe can sometimes send us the very thing that might facilitate healing. So for me I would not shy away from talking about your obvious injury but the key is to make it about your clients experience and not your own. I can imagine there might be some revealing projections by your clients. For example your client with anger issues might believe that the bruise was the byproduct of anger towards you and this might trigger a lot for them. Or your second client may go into caretaker mode (this potentially being a role taken on during their violent upbringing) and try to make the session about you and your eye. Stay alert to this and keep checking in the here and now to ensure the focus of the session is returned to your client. Be careful not to collude and start to reveal the reason for your injury. Your client’s projections will be far more useful to explore than the actual reality. The important aspect for me is to make conscious what is going on for them as they sit with your injury and to remain open to what comes.”

Kelly, trainee psychotherapist says:

“I would acknowledge it immediately with the truth. Nothing to hide.”


Our next Dilemma next issue

You recently started your first counseling placement and have started seeing your first client, Holly. Holly’s is coming to counseling to get support regarding her boyfriend and his depression. You have also volunteered to conduct client assessments at the placement. As you prepare for an assessment, you realize the prospective client was Holly’s boyfriend and so alerted your placement manager. You are told to go ahead with the assessment and check that the client (Holly’s boyfriend) was fine to talk to you (Holly’s counselor). The assessment goes ahead. Afterwards you reflected upon the potential impact of assessing Holly’s boyfriend and are not sure how to approach your next session with Holly.

What matters do you need to consider?

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