Supporting Therapists and Clients Through Peri and Post Menopause - Door Knobbing in Counselling













In Episode 359 of the Counselling Tutor Podcast, your hosts Rory Lees-Oakes and Ken Kelly take us through this week’s three topics:



Firstly, in ‘Ethical, Sustainable Practice’, they explore getting over cancellation guilt, looking at what therapist cancellation guilt means, why it arises, and how to approach it with compassion and professionalism.



Then in ‘Practice Matters’, Rory speaks with Ruth Hill about supporting therapists and clients through perimenopause and post menopause - challenging outdated views and reframing this life stage as one of growth, not decline.



And finally, in ‘Student Services’, Rory and Ken discuss the phenomenon of doorknobbing - those last-minute disclosures from clients - and how to respond ethically and sensitively in practice.







Getting Over Cancellation Guilt [starts at 03:09 mins]



In this section, Rory and Ken explore getting over cancellation guilt, examining the emotional impact on therapists when they must cancel sessions and offering compassionate strategies to reframe the experience.



Key points discussed include:




Cancellation guilt is a common emotional experience, especially when sessions are called off at short notice.



Ethically, prioritising self-care supports safer practice and protects the therapeutic relationship.



Cancelling when unwell models healthy boundaries and gives clients permission to do the same.



Communication is key - offer reassurance, alternative times, and avoid oversharing to prevent client worry.



Contracting for cancellations upfront can reduce confusion and help manage expectations.



Use supervision to explore guilt, recognise blind spots, and develop resilience in responding to these scenarios.








Supporting Therapists and Clients Through Peri and Post Menopause [starts at 21:57 mins]



In this week’s ‘Practice Matters’, Rory speaks with Ruth Hill, REBT therapist and sports scientist, who shares insights from her CPD lecture on menopause and its implications for therapy.



Key points from this conversation include:




Menopause is often overlooked, under-celebrated, or medicalised - yet it is a significant life stage deserving validation.



Therapists must reframe menopause as a natural transition rather than a deficit or decline.



Ruth highlights how REBT and the ABCDE model can help clients challenge perfectionism and internalised stigma.



Brain rewiring during menopause affects cognitive and emotional functioning - requiring compassion, not self-blame.



The therapy space should allow for honest dialogue, normalising experiences like brain fog or hot flushes without shame.



Menopause also affects therapists - being human and modelling acceptance benefits both client and practitioner.








Door Knobbing in Counselling [starts at 45:39 mins]



In this section, Rory and Ken explore ‘door knobbing’ - when clients make significant disclosures just before leaving a session - and how practitioners can navigate this with care.



Key points include:




A doorknob comment is typically a serious or emotionally charged disclosure made at the end of a session.



Clients may use this as a safety mechanism, dropping difficult truths when time is limited.



Therapists should hold the client emotionally and assess immediate risk if necessary.



Revisit doorknob comments in the next session with sensitivity - offer choice, don’t impose an agenda.



Supervision is essential when managing potential safeguarding issues or feeling overwhelmed.



Know agency policies and procedures - particularly for harm to self or others - and act accordingly.










Links and Resources



Counselling Skills Academy



Advanced Certificate in Counselling Supervision



Basic Counselling Skills: A Student Guide



Counsellor CPD



Counselling Study Resource



Counselling Theory in Practice: A Student Guide



Counselling Tutor Training and CPD



Facebook group



Website



Online and Telephone Counselling: A Practitioner’s Guide



Online and Telephone Counselling Course