A counselling service specifically for renal patients was created more than 25 years ago at Addenbrooke’s with just one person in post. Since then, it has evolved and developed into the thriving renal psychosocial team now celebrating 10 years at the Cambridge Dialysis Centre (CDC).
Meet the team:
- Ali Carnegie, specialist renal counsellor
- Gillian Chumbley, psychotherapist and specialist renal counsellor
- and this year the team welcomed Krupali Adathiruthi, specialist renal counsellor
We provide a specialist counselling service for renal patients at CUH alongside the renal social worker as part of the Renal Psychosocial team.
Being a renal patient can mean huge and multiple changes in physical health, often over many years. This may impact a person's psychological wellbeing, emotional resilience, ability to work, and relationships. They have to manage multiple physical issues and co-morbidities.
A big part of our job is working with patients to process their experiences and find ways of developing emotional resilience in the face of sometimes challenging treatments. Having kidney failure, or caring for someone with kidney failure, can bring about a mixture of feelings which can be hard to cope with and we work with a diverse range of issues brought by the patients.
What are the main features of the counselling role?
We are a diverse team and bring many different methods of working therapeutically with our patients. We may use problem solving, stress and anxiety management, mindfulness approaches, journal writing, dream exploration, drawing, movement etc. Essentially, we all work holistically and tailor sessions to patient needs, with particular emphasis on relationship as the central healing foundation. We take as a starting point what has happened to an individual, not what is wrong with them – our focus is on compassionate understanding rather than diagnostic labels. As counsellors we aim to work alongside our patients and as part of the fundamental therapeutic relationship, help find inner resources to allow change.
The intensity of the work is constant as we work alongside our incredible patients through massive changes in their lives. One aspect that is unusual for a counselling service is that, due to the nature of renal support required, we work with some patients for many years, on and off, throughout the renal pathway.
Renal counselling is complex and unlike any other counselling jobs we have known. Working in an empathetic and safe way with people in emotional distress demands a great deal from the therapist. Including being a skilful listener and communicator, we work with highly sensitive information so must be able to contain and work confidentially with a variety of issues.
We have to be dynamic, flexible, resilient, and know how to manage the highs and lows of working in this service.
To be effective in our supporting role, it is essential that we too have adequate input. We maintain membership of UK recognised professional accrediting bodies. Our personal clinical supervision is essential to keep us grounded and to support our mental health. Our ongoing CPD, networking and exchange of ideas with other UK renal counselling services keep us up to date with relevant developments and supports our best practice.
Which services and patient groups do you work with?
Renal counsellors are part of the multi-disciplinary team who inform, prepare and support patients and their families in choosing appropriate treatment options. We work closely with renal consultants, nursing staff, dieticians, the diabetic team and the palliative care team. Our renal social worker, Aimee Robinson, is a huge asset for our team and through her work we may liaise with community and charitable organisations and professionals within other statutory care services.
Renal counsellors work with adult patients on dialysis, low clearance clinics, the home therapies team and local transplant patients (pre and post). We offer face to face and phone sessions at CDC, and phone counselling to patients at Addenbrooke’s and the satellite dialysis centres in King’s Lynn, Hinchingbrooke Hospital in Huntingdon and West Suffolk Hospital in Bury St Edmunds.
Ali: One of my specialisms is working with marginalised/hard to reach patients, who may be fearful or suspicious of therapy, often using a transpersonal approach. I also specialise in facilitating group therapy.
Gill: My particular professional interests are working with patients suffering with PTSD and those living with long-term traumas, plus using the creative arts to facilitate communication, connection and community. I am a member of CUH Arts committee and am an Arts for Health champion, and with excellent support from CUH Arts, I have developed a Renal Arts Programme for both patients and staff.
What does a usual day look like?
Ali: We are based at the Cambridge Dialysis Centre (CDC) with a fully booked counselling clinic, seeing patients face to face or by phone - weekly, fortnightly, monthly or when needed.
We are a small team with no admin support, so there is always essential admin and service management to fit into the day, including referral processing, risk assessments, waiting list management, and advocacy.
Gill: A typical day may involve face-to-face counselling sessions in our dedicated room here at CDC or phone sessions. I also usually visit patients at the bedside as they dialyse at CDC. I may meet with new patients during patient education days; CDC staff will drop in to discuss patient needs and make referrals.
Our lively arts programme at CDC involves visiting artists and an outreach project with the Cambridge University Museums. I will facilitate artist visits when they come to the centre to work at the bedside with dialysis patients; I will brief and de-brief them as to patient and staff needs for that day. I may have a meeting with a member of CUH Arts committee or CUM staff to plan future programmes.
I may be working on a teaching presentation or meeting with Ali and Krupali to discuss service development.
How do you feel your role benefits our patients?
We see patients move from feeling at rock bottom to feeling able to manage their treatment and adjustments.
Ali: We know that the psychological impact of being a renal patient is multi-faceted and long-term. Through providing our service, we see the difference in patients feeling able to process the changes, adjust and adapt.
We see better treatment outcomes of physical health interventions when combined with specialist renal counselling.
Gill: We know from our feedback from patients that psychotherapeutic input can improve patient/staff engagement and communication and often improves adherence to treatment. I feel that most valuable thing I can offer patients is time. Life, including NHS life, is often experienced as a huge rush. I practice ‘slow therapy’ where the therapeutic relationship is fundamental. I listen and try to understand someone's inner world. I think that trying to make sense of the potential chaos of chronic illness is a worthwhile pursuit and takes time. Patients tell us that they are listened to more deeply than maybe ever before in their lives and that in itself can bring about major shifts for them.
Tell us a bit about your CUH journey:
Ali: I am a BACP-accredited counsellor with a psychodynamic and humanistic core training, qualifying 11 years ago. I joined CUH in February 2021, having relocated from Bristol via London during lockdown, to join the renal counselling team. I have previously worked in the Lister Hospital renal counselling team. Outside of my renal role here at CUH, I also work as a therapist in the Cambridge Psychedelic Research Group at Addenbrooke’s, which is a collaboration between CPFT, CUH and Cambridge University researching psychedelic treatments for mental health conditions.
Before joining CUH I worked as a therapist in substance misuse services in the community and women’s prisons, in private healthcare in Bristol and London, and at Cardiff University Student Counselling Service. My initial career path was as an electronic music journalist and PR consultant. I then trained and worked as a massage therapist and bodyworker for several years internationally. I am currently completing a Diploma in Transpersonal Supervision. I have run my private clinical practice since 2014.
Gill: I am a UKCP registered body psychotherapist, counsellor, teacher and qualified somatic trauma therapist working in the field for 25 years. I have been at the renal counselling service for 13 years, starting off at the dialysis unit on-site at Addenbrooke’s before moving to the Cambridge Dialysis Centre (CDC).
At Addenbrooke’s I offered counselling to adolescents as part of the young adult transplant team and the young persons’ lupus group. I have offered supervision and training to NHS staff and teaching to pre and post registration renal nurses. I enjoy engaging with research and have presented psychotherapy talks and posters at BRS/UKKW and VASBI annual conferences over the years. I think it’s important to let people know about the impact and usefulness of psychotherapeutic approaches in everyday life as well as in medical settings.
Before joining the NHS I ran a private clinical psychotherapy practice in Cambridge for 17 years, I was a Body Psychotherapy trainer and teacher; therapist and supervisor at Centre 33. Before my psychotherapy training, I was research immunologist at Cambridge University and in the USA.
We are pleased to welcome Krupali to our team. Krupali brings experience from her years in private clinical practice and her time working with Cambridge University students.
The CDC celebrating its first birthday in 2016
Link: https://www.youtube.com/watch?v=GpzIdTX3eHg