Working with specialist client groups, are they really that different?

David Phipps is a Counsellor working internationally. In his short article he describes how similarities and difference enable us to find a sense of belonging. Something he was not expecting to notice in the two primary client groups he works with, whom on the face of things appear very different, but share similar experiences, needs and difficulties.

Contributed by DAVID PHIPPS – MBACP, AECO, EAC Accred.

In providing therapy to different populations across the world, with particular needs and difficulties, I often notice how similar these particular needs and difficulties are. In this short article I hope to explore the ideas of difference and similarity as a therapist working internationally. To consider the role a person´s feeling and experience of difference or similarity, plays in how we develop our sense of belonging.

I hope that this article can generate further questions, as well stimulate reflection on your own caseloads and what you find yourselves drawn to when working or how you organise your work. How you have found – and shaped – your place of dwelling and belonging? Was it unconscious expression of some desire or avoidance, a matter of fact borne out of need to earn money, or a response to an external demand or offer?

To contextualise this, I need to outline my current working practice. I provide therapy as a white male immigrant now living in Northern Spain, having previously lived and worked as a therapist in the UK until 2018. I am typically approached by clients looking for “ex pat” support and therapy, and I locate myself on the International Therapist Directory Online.

I also work for a Community Interest Company (or “non-profit”) based in the UK, called rareminds CIC. For rareminds I provide specialist therapy and workshops for specific charities supporting individuals (and their family members) impacted by rare, uncommon, often genetic diseases or conditions. It is estimated that 1 in 17 people in the UK alone has a rare or uncommon disease, and indicates that although rare diseases may be individually rare, they are collectively common.

I hope this brief introduction gives insight into my current practice. I mainly work from a psychodynamic perspective, in particular working “in the transference”, as a part of my approach. I am also influenced by the work of Melanie Klein, and others who developed her ideas.

In working with “ex pats” or “immigrants” living in countries not of their birthplace or with “third culture kids” (ie children born to parents in a country in which neither parent is native) a common theme presents itself as a sense of “not belonging”. Whatever the experience of living in the new place, this sense of dis-connection and no feeling “at home” is fairly universal. This sometimes is described as the experience of not being a “part of the furniture”, but instead having found oneself having to adapt to the already assembled room. Often, this leaves people feeling disconnected, alien(ated) and at times anxious and depressed as a result of this lack of belonging and easy familiarity.

Inevitably, one´s history and early attachments, as well developmental experience across one´s life, shape and alter how one adapts to new environments. Often being able to describe this experience of “not belonging” in more detail – and the particular fine detail of the experience of it – is very therapeutic in its own right. This being typical of what tends to be brought to therapy, when working with such a client group. 

In working with clients who have rare and uncommon diseases, it is quite quickly noticeable that this client group share some experiences with my “ex pats” and “immigrants” client group. They too are in touch with their “otherness/difference” from those around them who are not living with the experience and impact of a rare disease or condition in their family.

Given the rare nature of the diseases that the clients I work with have, their conditions (and experiences) are frequently misunderstood, misdiagnosed and misinterpreted. Expertise and familiarity with any one rare disease is often lacking, by its very definition of being rare. Individuals and families often feel unsupported, unheard and isolated. They are not unlike “ex-pats” who have left the comfortable familiarity of “ordinary life” (without a rare disease) and are often from international sub-communities of rare diseases, “ex-pats” across the world who share their particular condition. I am struck by the cross over with my “ex-pats” clients, who often explore how they experience the “thoughts that others will not understand”, and the sense of being out of place, isolated or anxious about being both understood, and understanding.

As a therapist working in a country which is not my own by birth, I too experience a sense of “peripheral belonging”. It is this sense I draw upon with both my client groups, ie of also myself being “other”, an outsider and of not quite belonging or the sense of looking “back” at what has been lost or given up in order to pursue other desires.

I have been struck by the similarities between my two main client groups in a way that I had not originally expected, and especially the features of their experiences as “dwelling on the margins” that feel pretty clear to me now. I now wonder that perhaps the drive to “belong” or feel “at home” is so universal that it inevitably makes itself apparent in some way or another with all client groups.

I hope that in very briefly outlining my work and the two primary client groups I am working with, that I have outlined something of the many crossovers and similarities between the two that may not at first seem obvious. On the face of it, rare disease clients and “ex-pats” were not client groups I expected to share as many difficulties and experiences as they do. In this time of increasing nationalism and individualism it seems all the more important to notice the themes and experiences which we share and unite us, not just those that highlight our differences.

Author: David Phipps, Counsellor

David Phipps is a Counsellor with a background of providing therapy in Therapeutic Communities, Psychiatric Hospitals and National Health Services in the UK. Since 2018 he has lived in Spain and his focus has been on providing online video therapy to “ex pats” and “rare disease patients”. He holds the European Certificate of Counsellor from the European Association of Counselling (EAC), he is accredited by the British Association for Counselling and Psychotherapy (BACP) and Asociación Española de Counselling (AECO).


For further information on rareminds –

With thanks to Kym Winter (CEO of rareminds CIC) and Peter Berry (Supervisor), who both read an earlier version of this article.