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A common element of change that ran through all the interviews was a deepening sense of empathy with the client. The engagement with the self-reflective process prompted the clinicians to start to recognise the shared experiences they have with clients in the service.

Lucy: “We were all children once and we know what it’s like to be a child. Oh

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Rachel: “And the upbringing that you have or the family you are in which is out

of your control… I do think it puts you all on the same footing”.

Not only can the participants begin to mentalise about their client’s mental and emotional states, but they can also build a ‘felt sense’ of the client’s experience. Emer spoke movingly about the impact of this deepening empathy on her understanding of the client.

“And I don’t think that she has ever had that experience of being appropriately soothed when she needed it, so she has a very superficial understanding of emotional support and care”.

Emer is integrating her ‘felt’ response of attachment loss with the theoretical knowledge of attachment to frame a new understanding of the client which is non- judgemental. She was able to ‘see it’ and ‘feel it’ from the client’s perspective, which changed her way of being with that client, saying: “If I don’t have this awareness of

her, I’m meeting her and I’m not understanding her as a person”. This experience of

deepening empathy humanises the client and changes the focus towards a relational way of being with her.

Sarah recognises the change in her experience of empathy. She not only understands what it means to be empathic, but her empathy moves her towards an emotionally shared experience and one in which she is willing to be there with her client.

“So, although I can say ‘yeah, I’m empathetic’, I have to go that deeper level

and relive their experiences when they are talking about it and be there with them”.

Five of the participants acknowledged the humanity in the life situation of clients that attend the service. They recognised that people did not choose this life; rather, it was often chosen for them by the circumstances and families into which they were born.

Rachel: “it reminds you of how you are all human and how your experiences

can be similar to theirs, and how we are all the same… and how a lot of it is out of your control”.

This reduces the ‘othering’ of the client in which their mental illness is seen as a ‘choice’, ‘fault’ or ‘blame’. The client’s mental illness is not constructed as an internal

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pathology but a consequence of experience. The growing understanding of the suffering of others helps to build compassion.

Lucy: “you know what they never had a chance because we knew their mothers,

and this was probably the second or third generation in the filing cabinet”.

There is a real sense of sadness and vulnerability in how Lucy views the impact of mental illness on the family system. She uses language to juxtapose the sadness of the consequences of intergenerational impact of ACEs and the mundanity in which clients end up ‘in the filing cabinet’. There is both a literal and metaphorical meaning to this phrase. The literal meaning relates to the fact that multiple generations of this family have been attending this mental health service and they each have a clinical file in the filing cabinet. On a metaphorical level, Lucy recognises the generational impact that ACEs and trauma have on a family and the perpetuation of difficulties. There is a sadness and acknowledgement that babies can be born into a life of difficulty.

Elaine offers a contrasting experience of her reduced capacity to relate to the client when risk is introduced to the therapeutic relationship. When Elaine takes on the teacher role there is a shift in power dynamic from empathy based collaborative relationship to a paternalistic relationship where Elaine holds control and responsibility for the outcome.

“I kind of see myself as a teacher at times saying ‘oh you need to do this and do that’… being a little more authoritarian. You know, at the end of the day if there are safety concerns about the daughter we have to enforce that”.

Elaine’s sense of risk and threat had shut down her ability to mentalise about the client, instead invoking the paternalistic role of the service. She recognised the impact of this relational change on how the client perceived their care, saying: “She felt threatened

and at risk, so she withdrew from our support”. This block in empathy acted to rupture

the relationship and entrenched positions: “we were doing what was ethically right…

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