This curriculum offers a lens through which to approach the issues that arise in our practice. It is not meant to serve as an ideology one must accept; it is helpful and necessary that participants bring themselves into the conversation.

We will lay out the pitfalls and hazards common to this differently-boundaried and open-ended work — moments to keep an eye out for as you move with clients over time. Where things are blurry, it is your job to be honest and to seek clarity on the client’s behalf as well as your own.

When someone is in a state of “health” it does not mean they have healed from an illness or are not experiencing discomfort or distress; rather, it implies a harmony with living, and a capacity to experience beauty, humor, and amazement alongside sorrow and exasperation.

In general, we follow the feeling. The word “aesthetics” is often misunderstood. Aesthetic experiences, or sensory experiences, bring us into our bodies, grant us degrees of nuance and ways of tuning-in and receiving life. We aim to feel alive. For many reasons, the aesthetic dimension is ripe for therapeutic development.

A beautiful and effective response to suffering of any kind is to make meaning from it. But, what if you can’t find anything meaningful? We aim to cultivate an affinity for reality in our clients that includes plenty of space for meaninglessness.

We think of people as having an irreducible self and a created self — a part that doesn't change much, and a part that is more readily altered by illness, trauma, or circumstance. The created self is a highly therapeutic zone where we can help clients respond constructively to forces outside of their control. Living as a creative response to life.

When we approach clients with expectations about what they should be moving towards — satisfaction with life, a focus on pleasant sensations — they are forced to confine what they feel into a form that pleases us. Relational care aims to remove these expectations and create space for our clients to feel however they do.

A significant difference between a session at Mettle compared to a session in a typical medical care clinic is that our outcomes are measured by the clients’ experience of spaciousness and clarity: clarity about what they are experiencing, feeling, and perceiving.

With enough space, we remember that things that seem to be opposites are actually close neighbors: safety/danger, burden/relief, living/dying. We realize that living fully is about so much more than being comfortable, and that we can find states much more durable and less limiting than comfort.

Everything in a life is relational and based on your perspective. From a therapeutic point of view, this truth offers an enormous opportunity for agency: finding an honest frame in which a client can place themselves opens myriad opportunities for growth and reshaping.

In client-clinician relationships, the idea of the self and the other is tricky. We are expected to both stay separated from while moving closer to our clients. We will encourage you to embrace the paradox and commit to these relationships—to find a way to both hang on and let go.

Mettle Health is, in part, a reaction to the ills of the US healthcare system. It’s important to understand that palliative care is itself born as a corrective, nudging healthcare towards its fullest realization. Doing this work in this way implies activism.

Advocacy is the subtle craft of speaking up for/with a client whose voice might be lost in all of the medical shuffling. As a counselor, you can help amplify the client's voice. However, you can only go so far, and we’ll explore how to find and mind those limits.

We can imagine listening and communication as components of a tensegral structure: they are the bones, solid, yet not inert, holding the form of the interaction. If we commit to this structure, intentions such as “making space” and “active listening” become available, less deterministic and more a process of getting out of the way of the dynamic.

It seems like words are meant to describe reality, but reality so often flows from the word. Let’s remember to be as accurate as we can be, take care to not confuse words with the reality they only ever approximate, and delight in the delicate and subjective nature of human experience.

We can strive to witness our client’s journey from a place of intimacy, rather than one of emotional distance. In this way, we act as swim instructors, not onlookers from the shore — in the water with the client, modeling movement, and offering a solid form for them to catch their breath.

The traditional therapeutic model suggests clear and generally rigid boundaries between you and your clients. Although boundaries are a crucial part of safety, they are too often used to artificially reduce a relationship. Constructive boundaries change as a relationship changes, and may be differently placed, one client to the next. But how to judge and who's to say?

It is more than okay to love your clients — critically different from infatuation, investment, admiration, gain, or attraction. And there’s a world of difference between receiving and extracting. Whether you say “I love you”, how you show it, whether you feel it — these are the questions we will explore.

Endings in client-patient relationships can feel hard on both sides and for importantly different reasons. Being able to look directly at the gifts, challenges, and impact of your relationship is another way to honor the client, and yourself, for that matter. Completing them as gracefully as possible benefits everybody.