The Problem of Presenteeism in Counselling Private Practice and What You Can Do About It
Samantha Crapnell is the founder of Training for Counsellors Ltd and practitioner-facilitator of professional qualifications and continuing professional development events to support the training and ongoing development of counsellors and clinical supervisors.
Many counsellors consider what they do as a calling. Whilst being fulfilling, research shows that this can be a contributor to the negative impacts on wellbeing. This article explores the evidence of how and, if you identify with it, what you can do to mitigate it. The article concludes with a signpost to a free Energy Audit Self-Assessment tool.
A job, a career, or a calling?
The notion of ‘calling’ is commonplace in service professions. Its distinction from a job and a career is:
A job is the work we do to gain materially.
A career is the work we do to gain advancement and prestige.
When work is fulfilling and socially valuable, it is referred to as a calling.
In private counselling practice, these overlap. The profession is built on a model of professional development, progression and versions of advancement. The commitment to the calling drives the personal and professional development required for the role. The private practitioner may have wrestled with and accepted that they need to earn money from their work. They may still feel the tension of earning a wage from something they feel called to do.
The search for meaning
Research has found that 95% of counselling students began training because they considered counselling to be their calling. Many enter counselling training because they are searching for meaning. As well as the romanticism of being privileged enough to do value-driven work, there are important links to competence development and correlation with lower rates of burnout during counselling training.[1]
Once qualified and the initial honeymoon period has completed, there is a point in time where sustainability becomes a focus.
‘Fit’
Mention ‘fit’ in counselling and psychotherapy, and thought automatically goes to ‘fitness to practice’, which is the ever-present yardstick to ensure accountability to ethical practice.
More broadly, qualitative research associates calling with ‘fit’, purpose, meaning in life, a sense of being compelled to do the work, passion, and even an acceptable burden.[3]
Practically, there is also the question of how we fit our work life with our other commitments.
Reflecting through the lens of counselling private practice allows us to explore ‘fit’ more deeply. The alignment between a practitioner and their work (i.e., ‘fit’) is a central tenet expressed from early in counselling training. Professional bodies and, ergo, training providers speak of the personal moral qualities required to be a counsellor, shaping the counsellor-in-training to fulfil the requirements of what it means to be a good enough counsellor. Training is a continuous test of ‘fit’ and of the commitment to the call. Qualification is, for some, a confirmation of the ‘call to’ and the ‘fit within’ the profession.
Holding space and being present
Therapeutic safety is positioned within the counsellor’s understanding of themselves, their ability to form and maintain therapeutic alliance, and a strong commitment to ethics. Being present is part of that therapeutic safety, fully engaging in the moment without distraction from what is in the immediate, here and now experience. This level of attunement is central to the therapeutic process so that we can engage with the client’s here and now experience.
When presence becomes presenteeism
Presenteeism, the practice of being at work for more hours than required, or working when unwell, is recognised as a contributor to reduced employee wellbeing and productivity in organisations.[2] The Institute for Employment Studies recognises a higher prevalence of presenteeism among high-skilled white-collar workers, managers, people with high sickness, people with financial problems, workaholics, older workers, and others.[4]
As a private counselling practitioner, I identify with several of these, yet I work for myself. In private practice, there are layers of moral obligations, the commitments we make to our clients and the obligation to tend to self-care, self-knowing, and self-respect, for example.
Showing up in the profession to hold space for the client and the therapeutic process may, at times, feel or be perceived as a moral duty. Even though there is a calling to do this work, presence exists alongside the obligations of other roles, parent, caregiver, wage earner, business owner. If energy is depleted, if we are accepting more work than we should, if there is interference in the therapeutic space that relates to these other roles, we may be exhibiting signs of presenteeism.
Furthermore, the findings of research exploring presenteeism allude to how self-employment can be a causal factor in extending noble practices into unhealthy ones.[5] Comparing the employed and self-employed from over 43,000 participants, the 8,609 self-employed were more susceptible to presenteeism thinking, worked more than 48 hours per week, were less attentive to their own physical and mental needs, and used unhelpful coping strategies.
What can we do about it?
As private practitioners, we must recognise that we create our workplace culture! Chances are that you have recreated a personalised culture from your previous work experiences. For example, you may have replicated a task-focused culture where volume was prized more than quality. Or if you have come from a role where your ‘door is always open,’ it can translate into private practice as poor boundaries.
Reflect on previous cultural experiences of being an employee. How are these informing how you work in private practice?
Self-reflection. What are the internal narratives that drive your choices about when you are working or not?
Recognise the difference between moral duty and moral responsibility. Responsibility is accountability and ownership. Duty is about obligation.
Check yourself for slipping from presence to presenteeism.
Clinical supervision and connection with the community can provide a feedback mechanism for your choices about presence.
Introducing the energy audit: A reflective tool for practitioners
Emerging from this research and lived experience, I developed the Energy Audit, a self-assessment tool designed to help recognise the subtle signs of over-extension in private practice. By checking alignment across eight categories, physical, mental, emotional, relational, psychological, behavioural, financial, and spiritual energy becomes visible. This is essential in maintaining balance and well-being, sustaining ethical practice, and preventing the quiet slide to burnout.
Read more from Samantha Crapnell
Samantha Crapnell, Training Facilitator, Counsellor, Supervisor
Samantha Crapnell is a training provider and also in practice as a counsellor, clinical supervisor, and executive coach. Training for Counsellors Ltd was created so that counsellors can access alternative routes into and develop within the counselling profession through inclusive education and continuing professional development. Specialisms include anti-oppressive humanistic practices working with children, adolescents, and adults, neurodivergence, and solopreneurship.
References:
[1] Hurst, R., & Prescott, J. (2021). Counselling as a calling: Meaning in life and perceived self-competence in counselling students. Counselling and Psychotherapy Research. 22(1) p.p. 219-224. DOI: 10.1002/capr/12406
[2] BUPA (2023) Tackling presenteeism at work.
[3] Hunter, I., Dik, B.J. & Banning, J.H. (2010) College students’ perceptions of calling in work and life: A qualitative analysis. Journal of Vocational Behaviour, 76, 178-186. DOI: 10.1016/j.jvb.2009.10.008
[4] Garrow, V. (2016). Presenteeism – A review of current thinking. Institute for Employment Studies.
[5] Kim, M-S., Park, JB., Min, K-B, Lee, K-J & Kwon, K. (2014) Presenteeism among self-employed workers: Korean working conditions survey. PubMed Central. Presenteeism among self-employed workers: Korean working conditions survey – PMC
