Working in the Grey Areas

One great thing about my job (as a psychologist working in a church) is how much debate and interest it receives. Wherever I go, announcing that I work in a church always raises some eyebrows, and gets people talking. Usually their response is very positive. But occasionally I am met with some suspicion, particularly from people who work in more traditional caring roles within the NHS. After all, the church is very different to the more formal environments where they offer care and support, and this more flexible approach to care can make some people wary. I shared some of their concerns when I started work here, and I would certainly agree that it is a very different way to work. But my overriding conclusion as I work here day to day and week to week is that as well as some challenges, working within the church has its own parcel of great strengths. Many if not all of these come from the power of working in what I call 'the grey zone.'

Let me explain something of what I mean. Working as a professional in a clinic, or even seeing people as private patients, is full of very clear professional boundaries. Clients or patients have clear ideas of how and when they can get in contact with you. They come to see you in very specific prearranged time slots, and this is probably the only time they ever come to your office or building. For them the experience is one of coming out of their lives once each week or fortnight, taking that step into your office and exploring what they are feeling and experiencing, before returning safely to their everyday life. You do not overlap into their everyday life, so the whole arrangement helps to maintain this very clear boundary. Professionals are encouraged to work hard to maintain this and blurring the boundary (for example treating friends or contacting people outside of sessions) is frowned upon.

As a professional I have experienced working in this setting and seen the benefits to both client and professional. I am naturally a very ?boundaried? person in the way I work, and when training counsellors and other people involved in caring roles I always emphasise the importance of keeping clear boundaries and the role that these have in treating someone. However, I find myself working in an area where many of the boundaries are much less clear. Instead of things being black and white like this I find myself working in countless grey areas every week. And strange as this is for someone who has always been so keen to maintain very strong and clear boundaries - I actually see great strengths in this.

Church is full of grey areas for all leaders, especially those in caring roles. Of course this is nothing new and anyone who has pastured a church will have experienced this. But it is a new issue for many caring professionals who are now working within a church environment. Although I do lots of work in the community with people who may never come into church, a large amount of my work involves caring for our congregation. This means that people who are struggling with issues and who need more intensive support than can be offered by home groups etc, come in and meet with me or members of my team in the week for one to one support and prayer. What exactly this involves varies, but usually we are working alongside professionals from our local MHS, offering extra support, dealing with faith issues that have come up and also helping that person to work through what the main professionals involved in their care have been saying to them. We see a wide range of issues and situations, and often support people who are acutely unwell and experiencing considerable difficulties with their mental, emotional or physical health as well as their circumstances.

What we offer is 'pastoral care' - but our role with these people quickly becomes that of a form of therapist. Our approach is eclectic, choosing ideas, illustration and models from various different places in order to help the people we care for understand their situation better, make the best use of the professional care they are being offered, and ultimately to move on towards a better place. We are able to be flexible and to approach care in whatever way works best for the individuals concerned. We do a lot of work on motivation and strive above all else to help people find and believe in hope; we provide emergency support and crisis care and occasionally, working along with the other professionals involved in care, we work more proactively using things like cognitive behavioural approaches. But inherently our role does not fit into that comfortable black and white therapist-client model. Even though we always aim to link someone with a pastoral carer who is not likely to overlap with their group of friends or social group, inevitably we see the people we support on Sundays, bump into them in town or attend the same meetings and events throughout the week. In fact often we encourage people to come along to groups and events, which can be fantastic in helping them develop and work on social skills, challenge fears and anxieties or to simply improve their experience of life.

My first experience of these grey areas was to find them very challenging. I spent - and spend - a lot of time thinking about how I need to be careful about these situations where my role becomes blurred. The people I work with - my clients, for want of a better word, not only know me, but also through church they tend to know my husband and my child. They see me not just when I am being that 'professional', but in other circumstances, when I am just being a Mum, friend or wife. This very clear overlap of my work and non-work roles is one I am very careful about, but at times it can be pretty stressful and it raises lots of questions in my mind for both sides ? the clients and for my family. Working in the grey is hard at times and it does require extra care. It is absolutely essential to me that people I work with are aware of who I am and that I do have a private life within the church as well as my caring role. I am lucky to have a senior pastor who supports me absolutely in this, but I have to be realistic and admit that sometimes it is hard.

In fact if there is a negative side to working in the grey, it is on the whole something felt by the therapist not the client. Most people working in my profession are protected from some of the obvious potential strains of the job by those clear boundaries. We deal with emotionally draining, stressful situations day in day out, and it is important that we are able to close the office door on them at some point and go home. It is much easier for my work to follow me around (sometimes literally!), and to eat into my social time. I have to be very strict and careful about this and maintain 'work free' space, but this can be very hard when the people and places you socialise in are the same ones that you work in. For the sake of my family in particular I am very clear and strict about certain rules and other members of my teams work with me to help me maintain them. I also I try hard to pre-empt tricky situations with people I am supporting, talking through with them what they would do if they saw me in a social situation and had something they wanted to share, and exploring possible actions they could take. Sunday mornings are very rarely good times to talk in any depth with anyone, and we work hard to make time during the week when people can come to see us for more valuable one to one time when we can properly offer them our attention. I also explain to every person who comes for more intensive pastoral care that this is not the usual clear and safe situation you would experience with a counsellor or other professional - that they will bump into me in meetings, in toddler group, in services, in the church quiz night - the possibilities are endless! It is vital that they are aware of this, and we always support people to make good decisions about their care - and help them to find great support elsewhere when this is more appropriate.

Of course it isn't just for me that this is important. One of the difficulties for clients if they see their therapist regularly is helping them to learn better coping skills and ultimately to begin to be able to deal with their emotions and feelings more themselves. It would be so easy for people to become dependent on us, the church, as we are here most of the time in one form or another, and we work very hard to avoid this, often needing to work through deliberate programs and contracts of care to help them overcome this issue. We have to maintain the really important boundaries and encourage them to stick to them whilst also making sure that we have explained why this is important for them - as well as for us. Many times I have explained to people that if we just provide support, listening ears and someone to hug them when they cry, we risk helping them to stay in the painful place they are in by making it easier to bear. We do not want to do that - we love them enough to know that there is so much more ahead for them - and we therefore work with them to help them move on. That means that in the short term we ask them to do things which they will find hard at first. So we arrange clear times and appointments when people come for regular pastoral care and encourage them to stick to them. We offer prayer on Sundays after the services but ask them to bring their thoughts and feelings to their regular sessions rather than try to discuss them there and then. We work hard at talking to people we support about the challenges of this grey relationship we have - where we are definitely not friends, but we are not the clear professionals they might see elsewhere either. We work through the natural feelings of dependency that can arise anyway - and we help people to move on and develop independence - and learn just what they really can do on their own.

But there is something else that I am learning in working here which I think is something unique and powerful about the way we work. That is the strength of these grey areas. For we do not see these people in the clear cut professional way. Instead there is a real sense of us walking alongside them throughout their lives. We care for them in a more personal way, and we are able to have a much more influential role in their lives. Many times I have seen how we, working alongside a psychologist, psychiatrist or team from the local MHS, can help someone to make and effect real changes in their lives - and see genuine transformation. When you combine the expertise of a great mental health team - psychiatrists, psychologists, occupational therapists etc, with the power of God and the Holy Spirit, you can see amazing change. I relish the grey and what it means, and I see the power of it for the people we care for. I thank God for it, and I know there are people in our congregation now living happy healthy lives who quite possibly would not have been alive without that more risky grey area kind of support that we were able to give.

Care from the church is never going to be able to maintain boundaries as clean as therapy from other sources. But then I believe it should never pretend to be the same thing. We do not support someone just for the period they are unwell, then sign them off. We know them and support them throughout their lives. I can think of individuals who we have supported one to one through depression, anxiety, self harm, eating disorders, drug and alcohol addictions (the list is endless), but then also seen and supported as they have grown up in the church, experienced marriage, children, and all the challenges life brings! People we have supported often go on to become involved in our ministries and take on responsibilities within the church, and we are able to help them to do this and build on their confidence and self esteem at the right time in their journey. As one person put it 'in the darkest times I couldn't have any hope for me or see any reason to carry on living. But I knew that you believed in hope for me and believed I had a future, so I held on to that. Now that I have moved on so far I don't need that kind of every-week support any more. But it's great to know the church is still there for me, and if I ever did need something, I could come and find it here. I know you believed in me not just for the time when I needed you, but for the rest of my life.' In this way the church becomes the general practitioner of emotional care - there throughout life, a stable island of support people can always come back to.

I know I am not alone in sometimes finding the experience of working in the grey difficult. It is probably one of the most challenging aspects of working where I do, and on those bleak days when I wonder why do it, it is usually issues related to this which have brought me down! But it is essential that I am not too hasty to 'throw out the baby with the bathwater'. Professional training teaches us some great values and cautions where boundaries are concerns and I personally still work hard to maintain these where I can. But where they are blurred by the nature of the relationship I have with those I care for I also work equally to see the value in that - and often that's precisely where I also see God at work.
Kate Middleton, 23/11/2009