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Section 8
Menopause: Hot & Bothered

Question 8 | Test | Table of Contents

Don't laugh -- there are serious problems and challenges for menopausal therapists

Flash-Ease sounds more like a kitchen floor cleaner than a remedy for hot flushes. But then it is an American product and in the States, apparently, menopausal women have flashes not flushes.
However, the name is not the important issue. What interests me most is, will this product, manufactured by a natural health company, do the trick? Will I find ease from the discomfort of getting hot and bothered several times a day and night? Will I, after many months of self-consciousness, cease to have hot flushes when I'm counselling clients?

Self-disclosure is something I normally try to avoid. Coming from a psychodynamic viewpoint, I believe the less I put myself in the frame, the more my clients can utilise the transference and thereby benefit therapeutically. In fact, whatever our model of counselling, our focus should be on our clients and what's going on in their world.

So, when I started having hot flushes whilst counselling, I felt uneasy. Suddenly, my body was showing my clients very personal things about me. Then and now, I imagine my glowing, red face says, 'Look! I'm menopausal!' Or does it? Perhaps, even worse, my clients read my symptoms differently and think I'm embarrassed or anxious about things they're talking about. Indeed, my flushes, on occasions, do seem to be triggered by anxiety or distress -- as if mirroring is taking place, with my body reflecting the mood of my clients.

On the other hand, more optimistically, maybe my clients don't notice my redness and glowing skin as much as I think they do. It raises feelings of ambivalence in me. However, most importantly, hot flushes can easily take my mind off my clients for a while, and this doesn't make for best practice.

A case for supervision?
After months of tolerating these symptoms I decided to broach the subject with my supervisor -- a 50-something-year-old Jungian male. He already knew I was menopausal because I had regularly experienced hot flushes during supervision sessions. He'd responded with sensitivity and humour, asking me week by week, whether I needed the window open (even in the middle of winter?) or the heater on (hot flushes are often followed by cold spells).

I thought it might be helpful to ask him how other supervisees have handled their menopausal symptoms. Disappointingly, he couldn't tell me, because nobody else had ever talked to him about this matter. I then asked him how long he'd been supervising and what proportion of his supervisees were middle-aged women. Apparently he'd supervised large numbers of therapists over a 15-year period, the vast majority of these being women, many of menopausal age. In light of this, I was very surprised that I was the first person to raise the subject with him. Was I really the only overheated female therapist he'd supervised? Or have there been others too embarrassed to discuss this in supervision, particularly with a male supervisor? According to Webb and Wheeler(n1), there are certain sensitive subjects that tend to be kept out of the supervision room, for various reasons. Perhaps disclosing intimate details and feelings related to hormonal changes in midlife would create too much discomfort for some supervisees, even if a good supervisory relationship has been established. Indeed, there is evidence to support the notion that some women feel male colleagues judge them to be less attractive and competent once they become 'publicly' menopausal(n2).
Without the benefit of guidance from other therapists, I was uncertain about how best to handle my flushes with clients. My supervisor suggested that I could just tell them what was happening. He sounded enthusiastic about the idea of monitoring my clients' responses to my disclosure. For example, would there be an age or gender difference? At first I joined him in his enthusiasm -- then started to feel apprehensive. It seemed I would be electing myself to do some fascinating, but very time-consuming research -- something I most definitely did not want to do.

I was also concerned about the way in which my disclosure might change or influence the therapeutic relationship and frame. If I named and highlighted my hot flushes, would I be offering clients a less containing experience? For example, might they be worried that I wasn't strong or available enough to hold them and their problems?

Client responses
Nevertheless, I did act on my supervisor's advice and I have told clients what's been happening. It has been interesting to note the responses.
* All bar one of my male clients have reacted as if I hadn't said anything at all! The one exception was a middle-aged man who said, 'I'm not sure what I can do to help.'
* A 22-year-old female, with a helpful, compliant nature, asked if I'd like a glass of water.
* Two women in their 50s enquired if I'd tried HRT.
* The most interesting response was from a university student, whose presenting problem was a phobia of being sick in public, for fear of standing out in a crowd and being judged. When I told her I was having a hot flush, she replied in quite an angry way: 'Well, at least you don't mind being looked at?'

All these comments and silences have been grist to the mill therapeutically, shedding helpful light on clients. In spite of my reservations, I have found that disclosure can be a way of role modelling congruency. It can also offer clients the opportunity to separate out what belongs to them and what belongs to the therapist. In effect I'm saying, 'These symptoms are mine. They are not a direct result of the material you're bringing.' This might be important if clients have the idea that what they say is sometimes shocking, too much to bear or shouldn't be voiced.

However, I recognise that some therapists, especially from a more analytic stance, might question these opinions, believing that it's inappropriate and unhelpful for a therapist to get personal. They might also feel that such disclosure is more about therapists seeking to relieve their own discomfort than about their clients.

Feeling as if I was operating in the dark and needing to broaden my thinking on this subject, I decided to do two things:

Research
Unfortunately, my literature search proved disappointing. Research has more or less neglected the impact of menopausal problems on women in the workplace(n3). Even within the psychoanalytic literature there are few, if any, up-to-date studies of menopause(n4). I was beginning to feel that something needed to be done about this situation. I thought that writing an article for therapy today might be an effective way of banging the drum for menopausal therapists, in particular.

My next move was to make personal contact with therapists. Firstly, I emailed 40-odd members of the counselling group I've been a member of for several years. This group is primarily for the continuing development and support of therapists; offering talks, workshops and personal development groups to members. I invited any of these counsellors to contact me if they had been having problems with menopausal symptoms. Yet again, the small number of respondents surprised me. Only three women replied, and they all said they felt their symptoms had never made their counselling lives too problematic.

By this time, I was beginning to feel quite bemused. Where were others, in the same predicament as me? Fortunately, my colleagues and friends in the counselling world were sufficiently interested in this topic and in my search for menopausal therapists that word spread further afield. To my delight I made telephone contact with four women, all of whom had been hot and bothered with clients and felt very challenged by it. They had a range of personal reactions to experiencing sweats and/or red-hot faces:

* Loss of confidence
* Depression
* Anxiety
* Feeling that their careers were at risk
* Fears that their bodies were mirroring clients.

For example, talking about sexual problems seemed to create flushes. As far as disclosure was concerned, only one of the four therapists had told clients she was menopausal. She had decided to do this at the outset of therapy and had received several responses such as 'Oh, God? I've got it too' or 'My Mum has that'.

The other three didn't say anything to their clients:
* 'I didn't want to get personal and impose my stuff on them.'
* 'I let them have their fantasy.'
* 'If they said anything or had a look on their face, I could take it up.'
* 'It's a bit like saying there's a package coming, but you don't know when.'

Their suggestions for coping with hot flushes during sessions with clients do not create an endless list, but there are some interesting ideas:
* Relaxation exercises
* Breathing techniques: breathe in through nose and out through mouth
* Move forward in your chair, to cool down
* Wear sleeveless clothes
* Ensure windows are open
* Work to understand the triggers
* Stop drinking tea and coffee
* Make use of frozen freezer packs -- under loose fitting clothes!
* HRT. Three out of the four resorted to this in the end.

Apart from HRT -- which doesn't suit everyone -- there is obviously no quick fix to eliminating unpleasant symptoms. Despite my initial optimism, Flash-Ease wasn't the cure-all for me. Neither was the wide range of alternative treatments I bought from a local health shop. Instead, I have resorted to drinking cold water and having a steel-like determination to keep my focus on clients, whenever I begin to feel the heat rising. These simple strategies seem to make the situation more bearable and reduce my level of anxiety. I am also due to have a consultation with a homeopath in the next few weeks, so who knows?

Having gathered all this information together, it seems high time that this neglected, but critical issue is brought into the open. Reynolds(n5), who undertook a rare piece of research on this topic, entitled 'Distress and coping with hot flushes: implications for counsellors in occupational settings', says that for counsellors: 'Hot flushes are associated with increased stress at work for mid-life women, and yet remain largely unmentionable (especially by the women who are most distressed).'

Personality, Menopausal Symptoms, and Physical Activity
Outcomes in Middle-Aged Women

- Elavsky, S. and McAuley, E. (2009). Personality, Menopausal Symptoms, and Physical Activity Outcomes in Middle-Aged Women. Pers Individ Dif., 46(2). p. 123-128. doi:10.1016/j.paid.2008.09.014.

Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socio-economic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 150 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress.” You will not be required to provide us with these Journaling Activities.

Personal Reflection Exercise #1
The preceding section contained information about menopausal therapists.  Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 8
What were the five categories of personal reactions in menopausal therapists to experiencing sweats and/or red-hot faces while with a client? To select and enter your answer go to Test.