Clinical Issues at Holiday Times

psychiatrist-mental-health-doctorThe holidays are coming up soon, and I am thinking about how to prepare my clients for the issues that are likely to come up.  This is my first year in a practicum placement, so I also wonder how much to be available to see my clients during the holiday season.  

The time between mid-November and early January is a difficult time for many of our clients.  Family gatherings can trigger painful memories and can give rise to conflict over past or present disagreements.  Those who choose not to spend time with family or who are estranged from family may feel a heightened sense of isolation during this season if they don’t have relationships with a partner and friends.

In approaching the topic of the holiday season with your clients, I recommend that you adopt an attitude of curiosity and interest, free of assumption and agenda.  You have probably worked with some clients for a few months and with others for only a few weeks.  They will vary in their sense of trust and engagement with you and in their readiness to plan for upcoming events and gatherings.  You can bring up the topic with a general statement like “the holiday season is challenging for many people and I wonder if you’d like to talk here about some ways to take care of yourself during this time.”  This leaves an opening for the client to focus on the aspect of the season that is most challenging or to let you know that it isn’t a priority.

Some of the issues your clients may want to discuss are family gatherings, other social events, financial pressure, and managing stress.  Remember that your role is to support and collaborate with your client rather than to attempt to fix the dilemma.  Find out what specific difficulties have arisen in the past and ask how she would like to handle a similar situation in this holiday season.  It is usually better to apply skills the client uses in other situations or to make small adjustments in the familiar pattern rather than taking on a major change.  For example, if she has used a mindfulness exercise in other stressful situations, suggest trying that before or after a tense shopping trip.  If the client reports that the family gathering becomes heated and conflictual after a couple hours, ask if he could plan to leave after two hours before things escalate.

Regarding the question of being available to see your clients, reflect first on your needs for self care during the holiday season.  Our personal lives contain the potential for family conflict, painful memories, and feelings of loneliness as do our clients’ lives.  Be sure to make your decisions about taking time off from client work in a way that includes meeting your needs.  Consider the possibility that some of your clients will miss their scheduled appointments and that you will feel particularly frustrated or resentful if you defer your needs for time off and the clients don’t come in.

Once you have decided on your schedule for the holiday season, let your clients know when you will be out of the office and confirm the dates you are available for scheduled appointments.  Some clients don’t think in advance about the impact of changes in work schedules and children’s school schedules on their ability to keep an appointment, so it may help to reduce the number of late cancellations you have if you go through the calendar with them.  Provide your clients with information about emergency coverage during your absence, and develop a safety plan with those who are at risk or who anticipate particular difficulty at this time of year.

I hope you are able to use these recommendations for your clients and yourself in the holiday season.  Please email me with comments, questions or suggestions for future blog topics.