Based on the findings of the research and impressions that have emerged from exploring respondent comments and data and other information, as well as my own experience; I believe it is reasonable to note a few things that counsellors might find useful to be aware of when working with a client who has M.E.

· Remember that some people with M.E. have cognitive or physical difficulties that are not always readily apparent, and that such symptoms can change rapidly.

· Remember that some people with M.E. have had negative experiences of relationships they hoped or expected would be helpful, and might be sensitive to perceived psychologizing about their illness.

· Establish whether stigma or hurt from other relationships has impacted on the client and if so consider negotiating addressing this within the counselling.

· Consider my willingness to engage in work with a client who might expose my own issues around, body image, illness and physical decline, depression, existential anxiety, identity, power, control, helplessness and hopelessness.

· Describe the counselling approach being offered.

· Agree realistic aims and goals for the counselling, and regularly review these. Dispel unrealistic expectations.

· Clarify and affirm client achievements, work and learning.

· Be alert to the possible consequences of misunderstanding a client and explore what judgments or assumptions might have led to this.

· Be aware of feeling challenged, blamed, undermined, helpless etc.

· Remain aware that some clients with M.E. might be working through a grieving process that will take time and present as thoughts, feelings and behaviour that seem inappropriate.

· Remain open to considering if counselling is helping and is suitable for a client with M.E., or if their resources might be better invested in an alternative form of support.

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