What happens when someone receives a genetic diagnosis? In this episode of Good Enough Counsellors, I'm joined by Uruj Anjum of Saina Therapy.

Before training as a psychotherapist, Uruj spent nine years working within NHS genetics services, supporting individuals and families navigating conditions such as Huntington's disease and other complex inherited disorders. She now specialises in working with clients affected by genetic diagnoses, reproductive decision-making, grief, loss and family dynamics.

We talk about what therapists need to know when supporting clients living with genetic uncertainty, and how genetics may be lying behind presenting issues such as anxiety, grief, relationship difficulties and identity struggles.

Takeaways:

• The emotional impact of genetic diagnosis on individuals, couples and families
• Anticipatory grief and living with uncertainty
• Carrier guilt and the complex emotions that can follow a diagnosis
• How attachment patterns can influence the way people respond to genetic testing and diagnosis
• The impact of inherited conditions on relationships and family dynamics
• Reproductive decision-making and termination for medical reasons
• Supporting clients affected by genetic conditions in the therapy room
• How therapists can work confidently with clients affected by genetic diagnoses without needing specialist medical expertise

You can connect with Uruj via her website saiynatherapy.co.uk and on instagram @saiynatherapy

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Keywords: genetic counselling, therapy for genetic conditions, mental health and genetics, emotional impact of genetic diagnoses, family dynamics in genetic counselling, genetic testing and therapy, attachment theory and genetics, anticipatory grief in genetic conditions, supporting clients with genetic diagnoses, carrier guilt in genetics, navigating genetic testing decisions, anxiety and genetic diagnoses, therapeutic approaches to genetic issues, stigma around genetic conditions, building confidence in genetic counselling.

The information contained in Good Enough Counsellors is provided for information purposes only. The contents of this podcast are not intended to amount to advice and you should not rely on any of the contents of this podcast. Professional advice should be obtained before taking or refraining from taking any action as a result of the contents of this podcast.

Josephine Hughes disclaims all liability and responsibility arising from any reliance placed on any of the contents of this podcast.

Because my work in genetics, or sitting with families, individuals receiving these life changing diagnoses really evoked a curiosity and sense of, I wonder what's happening in between. You know, you'll have a genetics appointment that might be one, two or three appointments.

And so really left me with this sense of wanting to know what happens afterwards. How do people go on to support their mental health? How does this impact their family dynamics and the sort of the future foreign.

Welcome to Good Enough Counsellors, the podcast for growing a private practice without the pressure to be perfect. I'm Josephine Hughes, counsellor and creator of Therapy Growth Group, helping you get the clients you want and create the practice of your dreams.

Today I'm joined by Arooj, who brings a really interesting perspective into the therapy world.

Before training as a psychotherapist, she worked as a genetic counsellor in the nhs, supporting individuals and families, navigating inherited conditions like Huntington's disease and other complex diagnoses.

She now runs CyanF Therapy where she works with individuals and couples through an attachment informed lens, exploring things like genetic diagnosis, reproductive decision making, grief identity and intergenerational family dynamics. Alongside her clinical work, she also teaches CP CAB level 5 and level 7 attachment diplomas.

What I'm really interested in today is something we don't often talk about in therapy spaces, which is the emotional and relational impact of genetics.

So today we're going to explore what that can look like and what might sit underneath it and how as therapists, we can feel more confident supporting it.

So welcome, Aroosh, and it's really lovely to have you here, Having sort of had a chat with you a little while ago when you were sort of launching your private practice. But can you share about your journey?

Because I suppose a lot of us would be surprised to hear that you can do genetic counselling and then train as a psychotherapist. How do you get into genetic counseling and tell us a little bit about that side of your work.

Thank you, Josephine. It's so nice to be here today and it's lovely to see you again. You too.

I know we met some time ago when I was launching my private practice and we were having those chats around what support I might need in terms of coaching into how to establish my sort of next steps.

And honestly, I found that initial meeting that we had where you brainstormed quite a few things with me, it left a mark for me and so I went away from that and work through each of your recommendations, really. And that's where I am here today.

So it's really brilliant to come back in, in a way, report back as to how things are going and what journey I've been on. Yeah, so I'm originally Canadian, Pakistani descent, but Canadian.

This was all just before actually as into counseling and therapy, because my work in genetics or sitting with, with families, individuals receiving these life changing diagnoses really evoked a curiosity and sense of, I wonder what's happening in between. You know, you'll have a genetics appointment that might be one, two or three appointments.

And so really left me with the sense of wanting to know what happens afterwards. How do people go on to support their mental health, how does this impact their family dynamics and the sort, the, the future.

So that was the, the beginning of sort of my experience of, of doing that and training as a counselor, as a therapist, further training and attachment. And I knew that I was going to incorporate this genetic side or this knowledge that I've got with me into my practice, which is what I do today.

Yeah, yeah, that's.

It's just sort of really interesting because I suppose what came up for me then is the fact that you said they might, people might have two or three sessions and when you're talking about something that's absolutely life changing, that doesn't sound like very many sessions really. Did you find that when you were actually working in the nhs?

Absolutely.

So the amount of sessions feels so minimal for the gravity of the information in terms of navigating testing pathways, making decisions around genetic testing, whether that's before pregnancy, during pregnancy, as an adult, predictive testing for a condition that exists in the family.

And so that was where my curiosity really was sparked around, well, what's happening after these genetic counseling sessions or appointments in the genetics teams? Sometimes that would be with consultants as well, or multidisciplinary team settings.

So they wouldn't even necessarily get a lot of input from someone who has that sort of therapeutic knowledge then. So just sort of thinking about, you know, people who have got something like a diagnosis or even sort of considering the possibility of exploring it.

What do you think is really important for therapists to know? I know that's a big question, but what would the main sort of things that you would say? It's really important for therapists to understand.

I think for therapists to understand what's really important Is that this is underlying a lot of issues. This is sitting beneath what's bringing someone to therapy. So I gave a talk recently at the BACP conference about genetics in the therapy room.

And what I was saying there is someone's not going to necessarily come into therapy to say I've got this diagnosis. But they do sign a therapy because they know they can.

But they might be coming in with anxiety or they might be coming in with grief, they might be coming in with various other presentations. But actually underlying it may be a diagnosis within the family or difficult decisions that need to be made.

And so it's around exploring that, it's around being able to do that.

And I think long term work can be quite helpful and beneficial in going through some of those layers to understand basically how somebody then sits with uncertainty. Because genetic diagnoses will evoke uncertainty, light grief, ambiguous and anticipatory loss.

So what do you think we might miss? If we don't know a lot about this area, what sort of things? Would it be easy for us to just not sort of even ask about or just not notice?

I think that might be kind of seeing genetics as a medical diagnosis or if it is mentioned or brought in the room, feeling unsure about your own competency or around information gathering or figuring out, depending on which modality you work in as well. So that might dictate how you, how you approach this subject.

And so in the way that I work from an attachment lens, I'm able to weave in certain questions and exploring certain areas, of course, at the client's pace and as the relationship builds.

But to be able to acknowledge the weight and also the shift that can occur in identity for somebody receiving a diagnosis, whether that's in themselves and their child.

Yeah, because it's such a massive thing, isn't it? So how might attachment patterns show up with people who are experiencing this sort of diagnosis?

Oh, I'm really glad you asked that question. So when we're in a state of stress, right. We will activate our attachment system.

And so imagine if, you know, an example might be that somebody's pregnant and they're undergoing their scans and there's an abnormality that's found. And so of course, all of a sudden there's a lot of stress or uncertainty of what's found, what's the diagnosis? What does this mean?

Was there a history of this in the family? Is this happening for the first time? And so in those moments of stress or when we activate our attachment system, those defenses come into play.

And so that will be Whether, you know, some might want to get reassurance, some might want to get all the information so they can, you know, that go through perhaps anxiety spirals of trying to figure out or problem solve. Others might retreat, they might withdraw, they might distance themselves. And so it all depends on sort of how your attachment can come into.

Come into play in those stressful moments.

Yeah. Yeah. So I suppose sort of like as you listen to them, you can help them sort of understand that this is almost like the way they're reacting is.

Is based in almost like an historic way of being.

Yeah. And so it's about making sense of. Of that, giving space, but also validating and acknowledging the. The shock that they're experiencing.

And it's not just the shock of. Of the potential diagnosis, because diagnosis sometimes, Josephine, can take years. In some.

Some conditions, there's lots of research, clinical trials that people might, you know, that they might be part of to get to a diagnosis.

Oh, gosh. So it's not like just either, you know, yes, you've got it. No, you haven't. It's.

Well, there's a possibility that your baby might have it, but we won't know.

It depends. Yeah. So in that context, we can only test for things that are known, if you like.

And so there, you know, I see clients sometimes that have had that experience through pregnancy, but actually they don't get a diagnosis until after the baby's born, or some choose to make a really difficult decision to end the pregnancy. And that's called a tmfr, or termination for medical reasons.

And so outside of the prenatal or perinatal areas of the known genetic conditions, which there's thousands and thousands of, there's also loads that are still unknown or still clinically diagnosed. But we can't do a genetic test, if you like, because we don't know the exact genetic makeup of the condition.

Yeah, it's a learning curve, so it's ever evolving. There's so much more information being learned through ongoing research.

I spent a lot of time in St. George's when I was practicing in the clinical research, in particular with Huntington's disease, and working on trials to grow to that field of knowledge. So that even in conditions that are known, how can we work towards treatment or potential gene therapies?

It's just so massive, isn't it?

I mean, I've got a little bit of experience of this from the times when I worked with pregnant parents and knowing how very, very difficult it is and. Oh, you know, it's one of the things that's so, so difficult for people to face, isn't it?

And facing a decision as to whether they actually do choose a medical termination. And sometimes, like you say, there might be uncertainty there. And that makes it an incredibly difficult decision, doesn't it?

And something that you've got to live with afterwards as well. And when it's a position of uncertainty, it's just so, so difficult, isn't it? It's like a really hard decision to make, I think.

Yeah. Especially in that context of a medical termination is because it's a very much a wanted pregnancy. I want a baby.

There's so much in terms of attachment, hopes and dreams attached already. Sometimes we know even before conception, we can attach to a future pregnancy or the idea of a baby.

And actually, as you said, that adds so much more complexity in the grief that's faced or the support that's out there.

Yeah. Because I think it's, again, it's very difficult for people to talk about it's, isn't it? You know, and it's very difficult for people to. I think.

I think possibly, I don't know if you'd agree with this, but would you say there was stigma attached to, you know, termination for those sorts of reasons?

I think so.

And I think that's where we need to, you know, appreciate the wider context here in terms of families, cultures, backgrounds, religious beliefs, and all of that process can impact how someone feels in themselves, but also how then their family might react or how both partners feel perhaps, in making that decision.

Yeah. Because something you mention is something called carrier guilt. Could you tell us a bit more about that?

Yes.

And so in some conditions, for example, in a recessive condition, both parents need to be a carrier to have a child that would be affected by that condition, for example, Batten's disease. And so when a child as a health, as a carrier, you're healthy in yourselves, you wouldn't really know.

And actually, Josephine, each of us are a carrier for about three to five different recessive conditions, and we wouldn't know about it. And it's only when both partners are a carrier of the same condition, then you can have up to a 25% chance of having a child with that condition.

And there's loads of recessive conditions out there.

Once a child is diagnosed, then they might do, you know, carrier testing to confirm that the parents are carriers of this, to identify the cause, I suppose.

And so the guilt that comes of being carriers or having passed something onto your child, I think, isn't just reserved for recessive Inheritance, it's for all genetic conditions because it's been passed on. For those that have been passed on, the, the parents can feel this, this guilt. So in the work it's very much around understanding the science around.

We don't choose which genes we pass on actually, we can't even see them. We don't know which ones we're carrying.

And so sometimes a genetic change can be very, is a new event in the child because as you can imagine, we've got over 20,000 genes. And when they're replicating, you know, during that time changes, mistakes can happen for the first time as well.

Yeah.

And so a genetic condition isn't always inherited.

So it can be sort of like just a mutation that happens. Yeah, yeah. But I can really sort of identify with that sort of sense of am I the person who's responsible for this?

You know, if something happens to your child, there's that sort of sense of responsibility, isn't there?

And what goes alongside that, Josephine, as you say that is the families or certain families can have the silence or stigma around the diagnosis or the secrecy as well of trying to protect that or to keep that within or to not share that from perhaps that area of guilt or shame even.

Yeah. And it's a double whammy really, isn't it?

Because you're dealing with this diagnosis anyway and then you, and you've got all these sort of feelings on top of it and the way that you're reacting and I suppose there might possibly even be associated guilt about feeling like that too, in that, you know, in a way you're telling yourself you should be putting your child first. So why are you feeling like this? Why, why are you feeling sorry for yourself or whatever?

I imagine there could be quite a lack of compassion towards yourself as well when you're facing something like this.

Absolutely, absolutely.

And the work that I found, the long term work I'm doing with parents with a child, with those, you know, with a life limiting condition or really complex needs, is there's kind of these cycles, for example, of the child being stable and so there's bit more space, if you like, for the parent to feel grounded and to feel connected.

And then those periods of time where if the child is hospitable, hospitalized or there is medical emergencies going on, then that again activates that stress and can put you into this fight or flight mode really of caregiving and making sure that they're okay. And then again it settles again if there's a stability.

And so as you imagine, we keep Going through these cycles and each time there's like an anticipation, anticipation that is this the day or is this the time that something's going to happen and I'm going to, for example, lose my child? And preparing for that emotionally, whilst you're doing everything in your power to sort of support your child as well.

Yeah.

Over time. That's really. The weight of it is immense.

Yeah. Because it's sort of. I know you talk about anticipatory grief, don't you? So.

So this is sort of going on for people at the same time as maybe they're trying to navigate what can be quite a complex health system and getting the care that they need for their child as well. Because that in itself can be quite difficult, can't it?

You know, the waiting lists and trying to get your child the help that they need is in itself quite a demanding thing to be dealing with as well. So there must be a lot of stress just on that day to day basis, I should think as well.

Do you think sort of disenfranchised grief is part of what goes on for people as well?

Absolutely. Because there isn't like a name for this, is there? There isn't a label, there isn't something that others might understand.

And so there's a real sense of isolation within this grief process, or not having a name or this ambiguity actually around this type of loss. And it's around the diagnosis, it can be around the future.

So the future you've imagined for your child, for yourself, if that's a condition affecting you or future generations.

Yeah, yeah. Sort of thinking about what might happen in the future. Yeah, it's really massive, isn't it? A really life changing diagnosis.

And also I was thinking there's that sort of side when you see parents coping, you know, people sort of say things like, oh, aren't you amazing? You know, you're coping so well and they're sort of, you know, making the parent making out that they're a hero.

And that must be quite hard to cope with as well. That set of expectations that perhaps other people are putting on you about the way you're coping, you have to be brave and that sort of stuff.

What I hear from a lot of clients, I have no choice or I have to, but actually it's then what's going on behind the scenes, you know, what's happening emotionally or in that inner world.

How is this impacting not just themselves, their relationship with their partner, with, you know, within the family unit, if there's other children that do have the condition that don't have the condition, the overall dynamic, everything shifts and changes and it's adapting to this ever evolving need.

It's absolutely huge. And I think you work with couples as well, don't you? Is that right? Yeah. So what sort of comes up in the couple's work?

Is there, is there sort of conflict?

There can be, but what I find is the couples that I work with often are grieving together and it's about how do we make sense, space for them to explore that together. Because again, based on our own experiences and upbringing and our attachment styles and how we relate, we'll grieve differently, won't we?

Yeah.

And so how does that grief show up for the couple? What's that like for them? What's the impact on their relationship?

And I should think there might be some sort of like trying to protect each other as well from their grief. Maybe if. I know sometimes people just cannot help it, you know, the grief just spills out.

But I think sometimes for other people there's that sense of I've got to be strong for my partner. And I think that can, that can happen as well, can't it?

It's the space I suppose I create here for individuals and couples is for them to be able to talk about and explore the impact of the testing a diagnosis, a loss, and actually how they're navigating that, whether individually or as a couple.

Yeah, I mean, what's sort of coming up for me when I'm listening to this is how you, how you manage it within yourself as well. Because it is very deep work, isn't it? And it is dealing with the sort of unexpected side of life.

So how do you look after you when you're working in this field?

It's really hard work, Josephine. I'll be honest, it's very heavy work.

But it's also so rewarding to be someone that can hold clients at such difficult times and places in their journeys. And I have a very, very good and solid self care routine.

So in terms of the number of clients that I take on, in terms of how many I see in a day, what time of day I see them, the breaks I have in between. I work from home, as you can see behind me.

So walking is a really important part of my, you know, working routine of daily walks in the morning and I try to go out in between as well if I can, and using personal therapy, using my supervision and my support networks, because this is really, really difficult work actually.

And the more I'm applying that self Care, the more my work is taking me in an angle of, you know, I never wanted to be in a position to gatekeep this, this area if you like. And so as as a tutor on the Optima attachment diplomas, I'm gaining lots of experience in teaching.

And so I'm hoping that I can in the future perhaps create meaningful CPD or trainings for other counselors so that they can incorporate this into their work and that they can be in a position where if somebody does mention a diagnosis or genetic testing that they can go somewhere and get some CPD or get some be held. I'm working on a framework actually and it's really exciting to bring that here here today.

It's going to be called the SINA framework and I'm hoping that that will give other counselors something to be held by when working within the genetics area.

Yeah, yeah.

Because I think it's interesting actually I just want to circle right back to what you said at the start because you said, you know, people can come with all sorts of things, but underneath there might be this sort of diagnosis.

Do you think that's something that they want to talk about or do you think that, you know, they haven't made the connection or it's just sort of interesting when you said they might come for other reasons. I just sort of wondered if you could say a bit more about that.

Yeah. So I guess I have a biased view.

So most of all the clients that come to my private practice at Sinotherapy, their first sentence is usually I'm so glad I found somebody who understands genetics and they give. Giving a little brief background as to what brings them there.

But actually once that understanding is there, I find what we're doing actually is a lot of, if I can say regular therapy, if you like, around self esteem, around overthinking or perfectionism or you know, grief or different areas that you would typically work with. Yeah, with this understanding because there's always a layer that comes in.

There's always a layer that's deep rooted that makes sense once we incorporate that genetic element because I suppose it's a part of someone's identity or it becomes a part of their identity over time. Once that's, you know, a part of their, their journey.

So if we can incorporate that understanding or hold it at least, or be able to include it, not be an expert and not be, you know, a genetic counselor or a medical professional, we stay within our competence as a counsellor. But to be able to include that in a meaningful way for clients. I Think is what I hear as feedback has been what they find quite helpful.

Yeah, it's just really interesting to hear because it's almost like the genetic side is the doorway and then, you know, people come through the door and then it's therapy, as most of us would understand. Therapy. Yeah, it's just really interesting to hear you say that.

Can I just say, you know, at the very beginning when we were talking about genetic counseling.

Yeah.

And you'd said they may not encounter someone who's got like a therapeutic training.

I just wonder on, on the back of that, could I just add a bit more around genetic counselors because they are trained, you know, they've got lots of counseling skills training. So it's like a dual whammy if you like. They learn all about the genetics and they learn about counseling and so.

So they can't do long term work at all. And it's this short term work, isn't it? Because when we think of short term work it's six sessions.

But if they work in a way that they can work with one session or two or three, but they incorporate those counseling skills and that compassion and the empathy which is needed at times of such difficult diagnoses, especially in teaching hospitals, there can be a huge team because as you can imagine, so many conditions are rare.

And even today when people come into my practice, I've not heard of a condition because it's a new mutation in a gene that I've not heard about before, for example.

But I've got the skills to know where to go online to read up on this, to get a bit of knowledge and background to understand how's this going to impact the client or their child and what might they be bringing.

Yeah. So do you think it's important to understand that, you know, you actually do need to do that research?

Oh, of course, yes. When I was training as a genetic counsellor, there is no such thing as knowing every single genetic condition that would.

I don't know how many years that might take. You know, genetic counselors today, even consultants will, even of the known conditions will always research before seeing somebody.

What is the newest and latest information?

What's the latest research about a known gene or condition or one that we haven't heard, heard of before or the change is new and what does that mean?

So there's a lot of skills around research around searching databases and, and collecting information and translating it in an easy to, you know, explain way back to patients or clients.

Yeah. And imagine that must be. Is it difficult to do that? As in private practice, do, you know, just access to the databases and stuff.

Like that, so lots of information is available and so I do what I can do best. Of course I don't have access to any university databases, which then is a little bit tricky.

But there is lots of information already out there because I'm not trying to become sort of their genetic specialist. I just want to know enough.

I just want to know, or to also remind myself of something that perhaps I saw some time ago, that what do we know today in terms of medications, treatments, what's out there?

Yeah. So you just sort of bring yourself up to date. Yeah, yeah.

Because did you find as well, you're working in private practice, it's not the same as being part of a multidisciplinary team, because I was sort of thinking about the loneliness aspect of being a private practitioner and do you find in this field that that makes it more difficult or, you know, how do you find.

I would have said yes when I first started and I'm very happily saying no today.

Yeah.

And that's because I've got really great systems in place in terms of. Sinotherapy itself has grown to be a three member team now and so we've got our own internal team, which is.

We all work remotely, but it's quite nice to be able to speak to each other and do things together. I've got my teaching sort of. I think of it as different hats that I'm wearing.

So as a tutor, I've got a great group of colleagues and we're constantly in touch in terms of the teaching that we're delivering or putting together. Other. I've got great relationships with a lot of genetics or condition specific charities or support groups as well, so there's contact with them.

So I feel quite. It's not the same as it used to be where I used to go into, say a hospital and sit at a desk with this team around me.

It's not the same like that, but it's virtually, in a way I've created it, which I think also is really important because private practice can be very isolating, can't it, when you're in a way on your own or thinking about those next steps or what you're going to do with that Motivation to really keep going.

Yeah. I think, I mean, one.

I would just want to say what an amazing journey you've been on since we spoke, which was probably a year or so ago, probably maybe a couple of years ago, but it's just incredible to hear because we talked then about possibly, you know, you told me that you'd worked with, I think, Huntington's disease in particular. And I sort of said, well, how. How about putting that into your private practice?

And just to hear that this has developed so much and you've now got colleagues who are also working in the same area. And I guess you attract people from all over the country because you're working online and because it is a specialist area of work, isn't it?

So like you said, a couple people are saying to you, I'm so glad I found someone who can actually work with me in this area. Do you find that you get referred to referrals from the different professionals and charities that you're in contact with as well?

Is that one of the ways that you get new clients?

Yes.

So how that works is they're not able to recommend anyone if you like, but they've got sort of their own internal sign posting for individuals that part of the group or the charity. And so that's one way that referrals come through. My website has been doing really well.

I've been following your T tips from that first meeting around SEOs, around blogs and so people. And that's my question usually to new clients is how did you find me? Because I'm also curious as to where individuals are coming through.

And a new thing as well I've heard is chat.

GPT is recommending me to clients because people are putting that into, rather than Google, but into say AI to say, I'm looking for a counselor that specializes in this, this and this. And, and actually my name's been put forward for. For those.

That's fantastic. And that, that probably all off the back of your website because presumably you're blogging and talking about.

Yeah, it's really good to hear that it's working for you. It's. It's great. It's always really encouraging to know that.

What if suggestions were all the things you'd said to me. And I was thinking, I was, I remember that meeting and I was thinking, oh, I've got to be consistent with these things.

Like if I'm writing a blog or I've got a. To consistently do that, or I've got to consistently, you know, reach out to others and to.

In terms of social media, I'm finding that I'm doing a lot more talks and events as well as time's going on and I really enjoy that aspect of my work or being on a podcast like here today to share that information in a different format, you know, to reach hopefully other audiences, that's it.

I mean today obviously we're talking about it from a therapeutic perspective, but I think what will happen is when people maybe do a Google search for you, this is going to come up and they can get a bit of a taster if they wanted to listen into you as well.

So I think the thing is when you do have a specialism like you have, you begin to get known as one of the go to people to speak to in this area and it's really fantastic to hear that this is happening for you as you work away in the background. If listening to this story has got you thinking about your own private practice, I'd love to help.

I run workshops on finding your niche, communicating clearly with the people that you most want to help so that they can find you and ask me anything sessions where you can bring your real questions about private practice marketing. So sometimes, just like in this story, one conversation can completely change the direction of your work.

To get details of my workshops, just go along to JosephineHughes. As me training or check out the link in the show notes. But the question that comes up for me is how do you manage to do it?

Because I know you've got a young family as well, you've seen clients, so how do you manage to fit everything in?

You'll be surprised to know that I only work term time and I only work from nine to three. So within the school hours.

Yeah, this year I'm doing some further training so I'm working every day but usually I only work three and a half to four days a week. I think that's really important as part of my self care and the balance between my work which is really heavy and exciting and my family.

As you said, I've got a young family and I want to spend spend as much time with them as possible and not be sort of burnt out from work and all the rest of it. So I think boundaries for me for work especially need to be really clear.

And so within those breaks I get during the half terms or working term time I might have one day a week that'll work but I'm not working every day during those term time holidays. It balances out throughout the year.

Yeah, yeah. And presumably you're sort of fitting in blogs and stuff as part of that normal day to day working as we.

Say that I haven't written one in ages and I'll have to go back to my website and see when the last one was because I started doing these events and I started teaching and I started delivering. I've got a few things coming up at online events, and so there's quite a lot of that aspect that I'm doing.

So then the blogs are a little bit behind, but it's kind of finding a balance between. Between those areas as well, I think.

Yeah. And I imagine, you know, the thing is, is once the blog's up, it's up.

That's right.

And it can go on working for years. And it sort of sounds like it is. If the AI is recommending you at the moment, they're obviously still. Still working. So that's great. So what's.

What's sort of one thing you wish more therapists understood about working with clients who are affected by genetic conditions? If you had to check, just pick one thing, what would it be?

I think one takeaway for working with clients impacted by a genetic diagnosis is that it doesn't just impact them, that it is relational.

It will impact the way relationships inevitably change and also how others respond within those relationships and how that then impacts your client again.

And so it's this keeping that in mind that it's not something that's just medical or something that's just scientific, that someone else is gonna, you know, they're gonna have these appointments and things. It's around, it's. It's within them. It's within their. Their relational dynamics.

Everything will change once that diagnosis is made, or even for those where diagnosis isn't made yet, because that uncertainty is. Is massive.

Yeah. Yeah.

It's a really sort of interesting thought about that, I think what you said, because I think, you know, I sort of imagined that, you know, people just come up with a diagnosis. But the fact that you're saying people often don't know and they just have to wait.

It's a long time, isn't it, to presumably sort of see whether the child's meeting developmental milestones and stuff like that before you can really come to a conclusion. Which is huge, hugely uncertain for people, isn't it?

So I think it's one takeaway then, in a very concise way, is how do we hold uncertainty in the therapy room?

Arush, it's been fantastic to listen to your insights about this really interesting area of work. How can people find out more about you?

Thank you so much, Josephine. It's been wonderful to see you again. Actually, I've been following along all this time anyway and commenting away.

You can get in touch with me via my website, Sinotherapy or on Instagram LinkedIn. Again, the handle is at Sina Therapy And I'm very eager to. To meet others, to connect and to. To increase this knowledge within our field.

So don't be shy, get in touch and we can sort of work together.

Yeah. And it's fantastic to hear that you're doing more training as well.

So, as you say, be producing your own framework, perhaps producing some of your own CPD in the future, but in the meantime, people can check you out in online events on BACP and find more about you that way as well.

Absolutely, yeah.

Brilliant. Well, thank you so much for coming along. Really enjoyed the conversation and just, you know, highlighting the issues that.

That people are experiencing working with you. So thank you. Thank you so much. You're welcome.

It's been my pleasure.

Thanks for listening. Do come and join my Facebook community. Good enough. Counsellors.

And for more information about how I can help you develop your private practice, please Visit my website, JosephineHughes.com if you found this episode helpful, I'd love it if you could share it with a fellow therapist or leave a review on your podcast app. And in closing, I'd love to remind you that every single step you make gets you closer to your dream. I really believe you can do it.