In Therapy: Working through your first counselling session (part 2)

In Therapy- Working Through...

Welcome to this second instalment of working through your first counselling session. In this post, I will talk about what the counsellor will say to you and some questions they might ask you in the first session.

This is by no means a one-sided conversation, you should be able to ask any questions you have about counselling, the contract and anything else that might come up for you either before booking or during the first session itself.


There are two very important things to take into account when finding the right counsellor for yourself.

Firstly, you have to be comfortable with the person you will be working with. Some counsellors will call the first session an assessment session. I opt to take the first session as just that – the first session – but I am also conscious that I might not be the right counsellor for a client or they might not be the right client for me (I have to be honest with myself and you about the limits of my practice, otherwise I might do more harm than good, and that would be counterproductive for both of us). Take the initial session as an assessment of whether you can work together or whether you keep searching elsewhere. Maybe even ask the counsellor for other names you can consider. Don’t worry, we are used to these things and won’t feel bad or look at you in any negative light if you choose someone else or ask for referrals!

Second, you will most likely be nervous. You are meeting a new person after all, and you know that the things you will be talking about with them are not going to be easy. Just remember, the therapist is probably as nervous as you are – they are also meeting you for the first time!


Your therapist will not have any expectations for you to perform in any way. Especially if you haven’t been to counselling before, it will take a few sessions to get used to the dynamics and the way your counsellor works with you. Take your time and feel free to ask questions about the process. The counsellor will explain how they work – their main modality, their role in this relationship (in brief, to help you understand what is going on for you, and how to move forward using your already existent inner strengths and resources).

The counsellor will need to know a lot about you in order to help you, so speaking freely without censorship is the best way to help them and to help yourself. Having said that, nobody will rush you or push you into talking about anything you are not yet ready to discuss. The space is a safe space to talk and process your issues – at your pace! It is your session and your process, you can decide what is ok and what is too much. Your counsellor might point out how difficult things are and that you might want to get back to that at a later point. We can’t collude with not talking about what we might already see as the key to moving forward for you.


There are other bits that the counsellor might discuss in a first session, like endings, open-ended counselling versus time-limited counselling, and questions related to you directly.

Questions you might be asked

Have you had counselling before?

This question is important because it will give your counsellor a feel of the experience you might have had in the past. Was it a positive one? Was it helpful?

What are your expectations of counselling now?

Following from that previous question, this would be another question that would help the therapist know how to help you better and maybe clear some of the misunderstandings or negative feelings – if any – from your past therapy process(es), as well as explain how similar or different your relationship with them might be.

What brings you to counselling now?

Everything else discussed up to now will have been helpful to ease you into the therapeutic process and allow you and your therapist to get to know each other a bit better, before delving into what brings you to counselling at this point in your life. This is where you can begin to tell your story and start the healing process.

The end of the first session

The end of the first session might be tricky, as you might want to keep on talking or actually want to end the session a bit earlier as it might be too overwhelming. Using all of the time allocated is the best as it will help you build resilience from the start, and will allow you to experience your therapist’s abilities to contain your feelings of uncertainty and overwhelm. It might also give them insight into how you deal with endings, which will be important for each session and down the line when you decide to end the process altogether.


After the session, take time to breathe, and don’t rush into making any decisions from what you discussed. It will take time to work through anything you bring to therapy and the best thing to do is hold on to it, think about it, keep processing in your mind and heart, and discuss it with your therapist on your second session.

I hope this posts have been helpful to you and I wish you the best in your search for the right counsellor for you.

As mentioned before, what I write in these blogs comes from first hand experience of being a counsellor, as well as being a client myself.

If you think that I might be the right counsellor for you, don’t hesitate to drop me a line, or have a look at my website for further information on how I work.

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In Therapy: Working through your first counselling session (part 1)

In Therapy- Working Through...

Welcome to this week’s blog post. I have decided to start the year with this topic, as I can imagine a lot of us might be thinking about changing some things right from the start of 2018.

I will spend the next couple of weeks on this, as there is much to say about a first counselling session!

If you have any questions about what you read, or anything else I haven’t written about yet, do comment or message me and I’ll add it to my next post.


There are many steps that take place before you even get to the counsellor’s office. All of them have their moments, some easier, others a bit trickier to work through.

From realising, and accepting, that things have got too much and that you need to reach out for  help, to going onto counselling directories to look for the right counsellor for you, to then finally making initial contact with a counsellor.

These are all potentially nerve-wracking tasks, but important ones to get your life back on track.


Let’s move forward to the day of your first session. You have arrived and are about to ring the doorbell and meet your counsellor for the very first time.

What should you expect?

bacp ethical framework picture for pageNow, this is a bit of a loaded question, as every counsellor will have their own ways of practicing, but we do have ethical frameworks that we adhere to, and these are in general terms, the same for all of us.

You should expect at least a couple of chairs, facing each other – mine are set up perpendicular to each other (like the title image above) so we can have eye contact but also allows you the space if you are not feeling like making too much eye contact whilst discussing a particular topic, or while you get comfortable with me and the therapy process.

Some counsellors will have a waiting room, whilst others – like myself – might work from home or smaller offices, so you might be asked to get there at the agreed starting time to avoid you waiting out in the cold, for example.

20170810_114447.jpgLighting and décor is up to each therapist, but generally there might be a bookshelf or at least some counselling related books and magazines, a desk, a clock. I have the main light on for some clients, but others prefer only the smaller lamps. Whatever is more comfortable and safe for them to speak and work through what brings them to see me.

Some counsellors have their diplomas hanging on the wall, this is a personal choice so some might have them available for you to check if you wish to do so and they are not in plain sight. I have candles in my room, which some people might or might not like, so I give a choice of putting it out or keeping it on and remember each client’s preference on this.

In regards to the initial conversations with your counsellor, they will also vary but in general you can expect the following (note: this list is non-exhaustive and I am going by how I work and general guidelines for all counsellors in the UK):

  • Contracting

  • Filling in Contact Details and other relevant information

  • The counsellor will explain how they work and other practical and process related details

  • The counsellor might ask you a few questions regarding your request for counselling

  • Next steps are discussed

Contracting and filling in contact details

The therapist will usually have a pre-written contract for you to read and agree to the terms so you can start working together. These will usually include the length of each session, the fee for each session and agreement on how you will pay (at the end of the session, bank transfer before the session, paypal, etc.), cancellation policy and the responsibilities held by the counsellor but also by yourself as a client.

You can have a look at my contract by clicking here.

The therapist will also ask you to fill in a form with your details and sign when you agree the contract terms and are ready to start therapy with this counsellor. With the internet available to us, I now prefer to send the contract and details form via email so you can read it at your leisure and in depth, so when we meet for the first time we can discuss anything that you might want to clarify or add to, and it then allows us more time to talk about what brings you to counselling now.

There are many steps that take place before you even get to the counsellor_s officeAdd heading

So far we have looked at the initial contact and possibly the first 5-10 minutes of the session.

Next week I want to delve a bit deeper into what the conversation might look like for the next 40-50 minutes during the first session.

In the meantime, if you have any questions or comments, drop me a line below or in a message via the contact form.

Until next week..

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In Therapy: Working Through loss and grief (part 3)

In Therapy- Working Through...

Welcome to the third edition of the mini-series on loss and grief.

In this edition, I would like to go through the possible reactions – feelings and behaviours – that we might go through when working through grief and loss. I will spend some time talking about how therapy can help work through grief and loss.


As with any symptom, grief symptoms are telling us something. Something is not right within ourselves after a loss, and our body and mind are working through the instability and trying to reach a balance again.

So allow yourself to feel the feelings, to grieve. It is a natural process. It is a normal process. It is your process so work through what comes up as it comes up.


Denial, anger, bargaining, depression and acceptance are the five stage of grief, as described by Elisabeth Kubler-Ross. These might appear in that order or in a different order and take turns creeping back up.

These might be accompanied by difficulties in sleeping, nightmares, dissociating, feeling numb or like you want to escape; you might also experience distressing thoughts, frustration and anxiety; you might want to be on your own all the time or wanting to escape; it might seem that people don’t understand you – or they might genuinely not understand what you are going through.

It is important to know that these are all part of the process, and that they will be less overwhelming as time goes on.

In the next few paragraphs, I will talk about how therapy can help work through the feelings described in the past few posts.


An integrative way of working might be the best approach to helping someone work through their loss. Grief is a process, and this process will be different for everyone. The aim is to experience the loss and all the feelings it might bring – pain, depression, isolation, anxiety, guilt – and get to the point where new meaning in the survivor’s life is reached.

They can then move on to living their lives with the memory of the person they lost, without being stuck in the grief and pain as it was when they first started the mourning process.

I would work within the psychodynamic, person-centred and cognitive modalities to support my client in their grief process.

Some of the areas I would work with would be:

  • Challenging irrational thinking

    • as a way to being able to manage the strong emotions that come up.
    • Developing more rational ways of thinking- develop healthy negatives.
      • For example – “I can’t live without the person”, can be challenged with the fact that they are still managing to be here without their loved one.
    • Challenge belief systems around the loss
      • Someone going through grief might be less positive about their lives and their self-worth, they might have more irrational thoughts than before the loss
    • Attachment theories would support the person in their natural reactions to the death of their loved one. The bonds created during the relationship need to be re-thought and processed.
      • How will the client carry on with their lives without their loved one present?
      • Will they ever have a relationship like this again?
    • Review the person’s life in regards to how they feel their life will be after the loss.
      • How does this change their character and identity?
    • Allowing for transitional periods where an item of clothing, a photograph or something else that belonged to the person, might be carried around as a temporary substitute for their loved one. They might give the item up once they are able to internalise the memory of their loved one and what it means that they are dead.

All in all, the therapist must trust that their client can find their own way through the grief process,  with their support, and come out the other side with a renewed sense of self as they adjust to life without their loved one.

If there is anything I can help you with, do contact me via this link.

Note: this is the last blog post I’m writing for the year. Don’t worry, I will still be sending you weekly emails for the last few weeks of December, they might be more festive ones. I hope you enjoy them, and enjoy the celebrations!

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In Therapy: Working through loss and grief (part 2)

In Therapy- Working Through...

Welcome to this edition of my In Therapy mini-series on Loss and Grief, where I would like to touch on other types of loss and how we might work through them.

Last week, we spoke about sudden and predictable loss and grief. There are more types of grief, and this post will help you identify them (click here to read it).


Working through the breakup in a romantic relationship can take many shapes and forms, depending on the length and intensity of the relationship.

Questions such as: Will I be able to cope on my own? Why did this happen? How could I let him/her treat me like that for so long? Why didn’t I do this sooner?

Thoughts such as: I had the rest of my life with him/her planned, now I need to start again; I will never trust another man/woman ever again!; I will be sad and alone forever.

In practical terms, there are issues such as bumping into them at the shops and how to act or react; if you work together, how is that going to work now; what happens if you see them with someone else? What are they going through during this breakup, do they feel as bad as you? Have they found it easy to move on?

It gets more complicated if there are children or a mortgage involved. But if this doesn’t apply, then it’s just a matter of working through the pain of the breakup, whatever shape it takes, however long it takes.

I guess it depends on whether the breakup was as amicable as possible (you grew apart, you had different ideas of what your life was meant to look like, for example) or you left it in really bad terms (violence in the relationship, cheating, etc).

Re-thinking your life will start when you are ready, and you can then pick yourself up, take the things that remind you of that relationship and put them in a box and return them or give them to charity, or whatever you want to do with them.

You can start making new plans for your life without that relationship. Every relationship teaches us something. In time you can see what you can take from that relationship and use it to your advantage.

Talking through the breakup and everything it brings up in you with a counsellor might help you process the pain and move forward with your life.

Elisabeth Kubler-Ross has some great books on Life Lessons that might be helpful, both when working through relationship issues as well as when working through grief and loss.


Loss of health can be a frustrating time, whether it’s permanent or temporary.

I have worked as a support worker at a rehabilitation centre, where people go when discharged from hospital after a fall (usually older people), to recover, have physiotherapy, and heal before going back home.

They were usually over-confident in their abilities and angry at having to be looked after.

I had to hoist someone back into bed after telling him that if he wanted to get up he needed to call me. He looked at me like I was exaggerating. He didn’t after he tried to get up on his own and fell on the floor! That fall scared him and made him realise that I wasn’t patronising him, that we were both there for a reason – him to get support in doing what he used to do independently before his accident, and me to support him to do just that!

It can be such a shock to need someone to help do things that we used to do so easily, like getting up from bed, using the toilet, and other activities. It is understandable that they be cranky and upset when brought to this rehab centre! (nothing a bit of patience, compassion and humour can’t fix).

Being unable to speak can be highly frustrating to someone that used to talk normally before a stroke or an accident. Manoeuvring through the feelings of having to communicate in a different way, not being understood or wanting to express your anger and fears and being unable to.

These types of loss of health and more will be significant and will need to be worked through with patience and compassion on the side of the carers and family members. Imagine yourself losing your ability to walk, talk, be independent. Working through all the emotions that might arise after an accident or medical complication will take time and lots of adjusting.


Losing your job, your source of income and possibly career satisfaction, will bring its own complications.

How do you face yourself, your family and friends, and tell them that you lost your job due to redundancy, being fired, or quitting? What will you do for income now? Are benefits an option for you? How quickly will you get another job? Will you be homeless soon?

As with other life circumstances, we can learn from losing a job.

We can regroup and reorganise our lives so that we focus on what’s really important. We can prioritise what we spend our money on – budgeting might be necessary if you are relying on benefits or on your savings for a period of time.

Go through the feelings, see a therapist, work through what it all means and then pick yourself up and go get that job you want. Maybe it’s time for you to start your own business and this job loss is a blessing in disguise?


Losing a pet can be as hard as losing a family member or close friend.

Pets become part of the family and therefore losing them will bring up feelings similar to the ones described in the previous post.

So cry for your pet, miss them, talk about them, remember them. You are allowed and indeed important that you do process this loss.


Every change in life requires adjusting, working through the positive and negatives it might bring. Graduating highschool means you are ready for the big wide world, you can study what you want at University or you can go travelling for a year. Starting a new job means learning new skills, meeting new people and many new opportunities; it might also mean a raise in salary from your previous post. Moving to a new city is a challenge – it might be scary to be somewhere nobody knows us, we might feel lonely for a while, or we might enjoy the freedom of being anonymous!

Embrace change, but also honour your feelings of fear, anxiety, excitement at every life transition.

I hope you have enjoyed this edition and have found helpful tips and ideas to help you work through loss and grief.

If you need to talk, contact me here.

Until next week…

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In Therapy: Working through loss and grief

In Therapy- Working Through...

Welcome to this new mini-series on loss and grief – part of my series In Therapy: Working Through…


I’ve been thinking about the colder winter months, and everything that it entails: less sunlight and therefore Seasonal affective disorder or just feeling low, sad and melancholic; celebrations and anniversaries that might remind us of things to be grateful for, but also remind us of our loved ones that we might have lost.

So, as a way to provide information and support to you, my readers, through some difficult times, I thought I would touch on the topic of loss and grief.


The main type of loss that comes to mind when we talk of grief is the death of a loved one.

Other types of loss that affect us but – can be remedied – include job loss, the end of a relationship, moving city or house, graduation from school, amongst other changes that might require adjusting to. There are lots more, but I will focus on these for the next few weeks.

Some of us might have been visited by loss more than others, and therefore this topic and the feelings and process that follow are a “normal” or familiar part of our lives.

I have lost many people in my life – sister, best friend, grandparents, and others – through accidents, old age, crime, and suicide. It is not easy to write that here, but it is part of my life, and one I can’t ignore or avoid.

The feelings arise suddenly and randomly. The memories come in the same way. Some are good memories, but the worst is remembering exactly where I was when I received the calls and everything that moved inside my mind, soul and body as I tried to understand and process each loss.

I am sure many of you reading this can relate to what I’ve written. It is painful but important to understand what we go through when we lose a loved one and how to work through grief.

It never goes away as loss by death is permanent.

But the way we cope with it and the resilience we develop helps us to carry on with our lives, in spite of the heartache and in spite of missing our loved ones throughout the year – anniversaries, birthdays, yearly celebrations, bring them back to our memory and yet another grief cycle takes place. But each year it gets easier, even if only 0.001%.

It does get easier, but it needs to do so in our own time, and each of us will process the death of a loved one in a different way.


Death due to crimes, accidents or suicide can be some of the most traumatic losses. I speak from personal experience here.

There is no time to prepare. You couldn’t be there to help or save them. You weren’t there to talk them out of harming themselves to the point of death. You couldn’t have prevented that stray bullet to hit them; you can’t stop crimes from happening.

It is becoming more and more common to hear of terror attacks in Europe, and people with mental health and other problems committing crimes where dozens or thousands of people are killed without real reason.

Budget cuts like the oned that might have led to fires such as Grenfell Tower and other avoidable situations. The trauma that comes with these sudden attacks and catastrophes is unbelievable and unbearable. It is so difficult to understand that it complicates the process of grief.


There is a slight difference when loss is predictable – for example when a loved one is diagnosed with a terminal illness and given a few months or years to live.

The difference is that we have plenty of warning to prepare, even if it’s just a week. We can start to work through how life will be like without them, what to do to make their last days more bearable. There is time to make a few more memories with them before they go.

You can prepare for the imminent death. The rest of the grieving process will take its own form, and most likely will be very similar to the process described in previous paragraphs.


Before I end the post for this week, I would like to leave you with a few ways to think about grief and process it in a way that makes sense to you.

– It is important to keep in mind that every feeling that we experience after the loss of a loved one is valid.

– Don’t let anyone tell you that your grief is not normal, or that you should be “over it” by now. How are you expected to get over something so final?

– You are the owner of your feelings and therefore also your grief when it hits.

– Work through it at your pace and as it comes up, however, whenever and wherever it comes up.

Next week we will talk about the typical grief reactions and about what happens when we end a relationship, when we lose our health, a job, our financial security, and what grief might look like in these cases. I will also give you more ways to think about grief and how to process it.

If you need to talk about what I’ve written about here, don’t hesitate to contact me.
Until next week….

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In Therapy- Working Through...

In Therapy: Working through anxiety (part 3)

In Therapy- Working Through...

Welcome to the third edition of In therapy: Working through anxiety.

In this post, I would like to talk about how therapy can help work through anxiety. As mentioned before, I will write from the perspective of what I do in the counselling room, what feels congruent and most helpful to my clients.

In another post, I’ve described the focus and goals of each of the main approaches I use – psychodynamic, person-centred and cognitive-behavioural – and mentioned other techniques and modalities that I might use.

Let’s get right to it…

As we talked about in the first post in this mini-series, anxiety is a response to danger, which was essential for survival in the times of cavemen. These responses still remain in us as fellow human beings, but are now triggered by different situations – not imminent danger, but still perceived as such.

My aim in working through anxiety with a client is

  • to understand the problem and how it came about

  • to trust in my client’s inner strengths and resources to work through what brings them to therapy

  • to challenge the thoughts and feelings that are expressing themselves in the form of anxiety


A psychodynamic approach will focus on understanding the roots of the problem. These roots are usually unconscious and originated in the client’s past. These past situations might have happened in the client’s childhood, or due to a trauma.

In brief, the thoughts and feelings linked to the situation that caused distress in the past, are most likely hidden – or repressed – in the client’s unconscious mind. This means that these thoughts and feelings are outside of the client’s awareness, and would cause the same or greater distress as when originally experienced.

The Ego acts as the guardian of the person’s consciousness, and when the unconscious tries to bring up the repressed material, the Ego will make a sort of deal with it and say “you can’t come out like this, it will be too much for the client, come out like this instead”. And the alternative way is where symptoms come about – in this case, anxiety symptoms.

Maybe the individual didn’t have a chance to develop good affect regulation skills due to neglect or other parental deficiencies, including insecure attachments; maybe the client didn’t have good models on how to deal with different situations in life. Therapy is a way of re-learning some of the things that the client might have not developed growing up.

It might take time to get to the origin of the anxious symptoms, but once it is reached, the change that I see in my clients is organic, and long-lasting. It is by processing the unconscious causes of anxiety that therapy can restore or develop better ways of dealing with situations – past, present and future.

3Therapy doesn’t give us amnesia, so what we experienced will still be present in our minds, but we will have built up our resilience, our coping mechanisms and our understanding of what we are experiencing in the present as anxiety. We will be able to work through anxiety and be better equipped to carry on with life much quicker than before therapy helped us understand and process our thoughts and feelings.

I work in a Person centred, in that I believe in the client’s ability to self-actualise and to build the resilience and skills needed to live a happy life, in spite of the situations that might be leaving them feeling stuck at present.


In regards to cognitive-behavioural techniques (CBT), I believe it’s important to challenge negative thoughts that the client might bring. CBT sees anxiety as an exte
rnal stimulus, and therefore works with the client’s environment which might be the cause of their symptoms.

I take from CBT the fact that the client might need to:

  • reframe the risk that they might be under – are they in any real danger or can we work on the perceived danger and what the real consequences of the anxiety-provoking situation might be;

  • be able to work through the situation as it is happening – through developing breathing techniques, self-soothing talk, talking themselves away to regroup, and others I have written as tips in the past two posts.

Challenging the client’s thoughts and behaviours regarding anxiety-provoking situations, together with understanding the origin of the problem, are an effective way of working through anxiety.

Finally, using prescription drugs such as anxiolitics and mood stabilisers is a good, temporary solution, but ONLY IF used as a way to help the client be more present and able to think about their issues in therapy. I don’t believe that drugs in themselves can solve the internal conflict that leads the client to anxiety. I believe they help but not long-term. And not on their own.

If you have any questions or comments about what you’ve read, you can leave them below or message me privately.

Next week look out for a new topic in the series In Therapy: Working Through…

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In Therapy: Working through…Anxiety (part 1)

In Therapy- Working Through...

Welcome to In Therapy: Working through…

In the next few posts, we will be discussing anxiety, what it is, its causes, consequences, and therapies that help work through anxiety issues.

I will also be leaving you with some tips on how to work through anxiety in daily life.


Anxiety can be defined as a feeling of worry or unease about something with an uncertain outcome. It is something that happens to all of us at different points of our lives. It can be triggered by a variety of situations, both external (social or life situations) and internal (thoughts, feelings).

Anxiety has a history. In the days of cave-people, anxiety was helpful in keeping our fellow man alive. If there was danger, the person would get an increase in adrenaline, which would allow him to run faster or to defend himself from that danger.

Nowadays we don’t have the same kinds of dangers, but our bodies are still very similar to that of the caveman. Adrenaline still kicks in when we are in a situation we might consider frightful or dangerous, and our fight or flight (others include freeze, flop) mechanisms might kick in.

We might not have a cheetah looking at us like we’re their next dinner, but seeing that person that has bullied us in the past might give us the same feeling. Sometimes we might feel anxious over every day events, such as taking a test or going for a job interview.

Anxiety is normal, even though sometimes distressing. There are ways to work through it and find the coping mechanisms that will make it more manageable and less debilitating.


As with self-esteem, which we looked at in the past few blog posts, the symptoms of anxiety might be physical, psychological or behavioural.

Physical symptoms include:

  • Increased heart rate and palpitations

  • Increased muscle tension

  • Feeling wobbly on the legs

  • Breathing more quickly or having difficulty breathing

  • Feeling the need to use the toilet more often

  • Feeling sick

  • Feeling tight chested

  • Headaches or migraines

  • Increased sweating

  • Feeling flushed or blushing

  • Dry mouth

  • Shaking

Psychological symptoms include:

  • Thoughts

    • “I am losing control”
    • “I am going mad”
    • “I am going to die”
    • “I am ill”
    • “I am going to have a heart attack”
    • “I am going to be sick”
    • “I am going to faint”
  • Feelings

    • “Why are people looking at me”

    • “People know I’m anxious”

    • Feeling surreal – detached from their surroundings

    • Feeling like things are going much slower or faster than they actually are

    • Flight

    • Feeling tense, restless, high-strung, hyper


      • Avoidance of situations and people that we believe cause us anxiety. This might be real or imagined causes.


The list of anxiety disorders is extensive, and we won’t have time to go through them all individually. If you want to find out more, please go the Anxiety UK Website (the list below is taken from this website). If you would like me to write more in depth about any of these, and how I might work with them in session, please leave me a comment below or send me an email and I will include this in future blog posts.

  • Agoraphobia
  • Body dysmorphic disorder
  • Claustrophobia
  • Generalised anxiety disorder
  • Obsessive compulsive disorder
  • Trichotillomania
  • Health anxiety
  • Panic attacks
  • Post traumatic stress disorder
  • Social phobia
  • Social anxiety disorder
  • Specific phobias
  • Depersonalisation disorder
  • Seasonal affective disorder
  • Irritable bowel syndrome
  • Separation anxiety disorder


  • One way of working through anxiety when it gets overwhelming, or even to prevent it, is looking after yourself in different ways. Click here for my series on self-care, which might give you some ideas into how to do this.
    • Have a bath
    • Spend time with friends and family
    • Find time to be on your own
    • Find a hobby or activity that you enjoy
    • Keeping fit
    • Get in touch with nature
    • Honour your feelings and set healthy boundaries
  • Meditation techniques might also be helpful
    • Breathing
    • Yoga/pilates
    • Mindfulness
  • When the thoughts or feelings that cause anxiety show up, challenge them with different, more positive ones. This might take a lot of work, depending on how anxious you get. We will discuss a bit more in the next few blog posts.

Until next week….

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In Therapy: Working through self-esteem issues (part 3)

In Therapy- Working Through...

Welcome to part 3 of the Self Esteem posts

In this final part, I would like to give some insight as to what might take place in a therapy session when working through self-esteem issues.

The way I’ve decide to do it is to pick a few therapy modalities and tell you a bit about what they might focus on, what they might consider a goal for their client, as well as what methods – the words, activities, challenges – they might use.

If you are interested in reading more about the vast variety of therapies that exist at present, please visit this post from GoodTherapy.Org.

So, without further ado, let’s see what therapy looks like when working through self-esteem issues…



  • This therapy draws on the importance of play in the child’s development in all areas (social, emotional, cognitive, physical).
  • Therapy with children might be different than that with adults, as children are still developing their emotional language, and possibly their language skills in general, depending on their age.
  • It might therefore be easier for a young person to communicate their feelings and thoughts through the medium of play.


  • To help the child express themselves.
  • Through play, the child will make sense of what they might be going through or struggling with.
  • To develop the child’s trust in the therapist so that effective work can take place.
  • The specific goals when working on self-esteem issues might relate to
    • reducing anxiety about their abilities, being rejected, being good enough or being sociable
    • improve confidence in their abilities and their personality and individual choices.
    • To sum up, a decrease in the consequences mentioned in part 2 and an increase in the kind of things mentioned as part of the tips throughout these posts.


      • turn taking games;
      • teaching autonomy by allowing the child choose what they want to do during the session;
        drawing or colouring;
      • visualisation;
      • reading stories or telling stories related to the child’s presenting issue.
      • For example, in the case of self-esteem, they might read a book about a child, like this one on the right.



  • Unconscious processes – these happen outside of consciousness, so we might not be aware of them. We might have put them in the back of our minds as they are too overwhelming to even think about.
  • Psychodynamic therapy will focus in the origins of low self-esteem.
  • Depending on the client’s age, it will delve further back in life or delve to the more recent past.
  • In the case of children, it might be working through issues that the young person is going through at present. These were mentioned in the causes of low self-esteem in part 2.


  • The aim is to develop a trusting and positive relationship with the counsellor in order to replay, in the sessions, those experiences that left them feeling negatively about themselves and struggling with their relationships, careers, and with themselves.
  • The side effects of low self-esteem (depression, loss of hope, anxiety), might need to be worked through as a means to the end of increasing their self-esteem.
  • With children, the process might be similar but I might include play therapy in order to understand my young client, and therefore help them understand what they are going through and help them work through it.
  • Learning to rely on the therapist will allow them to develop a sense of trust in others in their world.


  • To give the client the skills they might be lacking due to neglect, bullying or other life issues that might have impacted on their development.
  • Play therapy might be one of the methods used, especially when working with children.
  • Teaching the child to be assertive by working through examples that the therapist might give or from a book.
  • If the child is able to talk about their issues verbally, then use the child’s own stories as they can work through how they can tackle this situation or similar situations in the future.



  • This approach focuses on the here-and-now.
  • The therapist is warm, genuine and empathic.
  • The therapist trusts its client’s ability to work through the issues they bring, and to bring about the strengths that might have been quietened or neglected due to their life issues.
  • This is facilitated by the therapeutic relationship.


  • The therapist’s trust in the capabilities and strengths that already exist within the client, and the belief that they just need to be brought back to action; They might have been neglected or put away due to low self-esteem, and by working through this, the client’s strengths become stronger and their self esteem therefore increases.


  • To match self-concept with reality;
  • the therapist is there to encourage and listen, and facilitate the client’s search for their truth.
  • To increase the person’ss self-worth, and help the client become a more fully functioning person.
  • All of this is achieved through the therapist being congruent with the client, being unconditionally accepting of the client and being empathic toward their client.



  • It focuses on behavioural and thought patterns that might keep the child or adult stuck.


  • To restructure and change those thoughts that keep the client feeling not good enough, unlovable, and acting or feeling defeated.
  • If the client learns to act more confidently, they will be come more confident.
  • CBT uses homework and charts to challenge the behaviours and thoughts and to come up with new, more helpful and positive ones.


  • cognitive restructuring is used to identify unhelpful patterns of thinking and learning new more helpful ways;
  • for self-esteem issues the target might be changing the negative assumptions the child has of himself;
  • I would challenge and ask for proof that they are unlovable or whatever their negative pattern of thinking might be – usually there is little or no proof, and more evidence that they are indeed loved by lots of people!
  • I also use problem solving with my young and older clients, in order to empower them to successfully work through their problems, and stop feeling like the victim in life.


  • I also use techniques from Transactional Analysis (Ego States; scripts; strokes) and Gestalt therapies (chair work, role play), as a complement to the three mentioned above. These two therapies are grounded on elements from psychodynamic, cognitive and person-centred.

  • The chosen modalities are some of the ones I draw on to work with my clients. They make sense to me and my style of working, and they have proven effective when I’ve been in the client seat, as well as when using them with my clients.

  • This list is by no means exhaustive. Do have a look at the link mentioned at the beginning for a more exhaustive link.

New topic for this series coming up next monday! See you then!

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In Therapy: Working through low self-esteem issues (part 2)

In Therapy- Working Through...

Welcome to part 2 of the Self-Esteem series-in-a-series!

This week I want to briefly touch on some of the causes and consequences of self-esteem. More information can be found by visiting this NHS link as well as The Self-Esteem Institute website.

1.pngSome of the causes of low self-esteem might be internal to the child or individual, such as thoughts and beliefs they might have of themselves. Others might be related to their family or social environment and other life circumstances.

  • Internal thoughts and beliefs
    • Feeling like their feelings or thoughts don’t matter and aren’t valuable

    • Feeling like others don’t value their feelings or thoughts

    • Negative self-messages like “you’re not good enough”

    • Unrealistic expectations the child puts on him/herself

  • Family environment
    • Parents might be distracted by other things going on in their lives, inadvertently neglecting their child’s needs. This could be due to a parent’s preoccupation with their career, with relationship issues, mental health or substance misuse issues.

    • Unrealistic expectations are put on the child

  • Social environment
    • Being bullied at school

    • Being disrespected by their peers

    • Feeling pressured to do things that they don’t really want to do

    • School stress and anxiety

  • Life circumstances
    • Bereavement

    • Illness – their own or a loved one’s

    • Disability

    • Learning difficulties like dyslexia

    • Suffering trauma or abuse and the shame and guilt that comes with it

  • Struggling with daily life-Need someone to talk to-I can help you.Click here to find out more. (1)A child’s personality might also influence their self-esteem as they might be more prone to
    • negative thinking

    • setting unrealistic goals and expectations

    • having a negative body image


There are cognitive, emotional and behavioural consequences of having low self-esteem.

Cognitive consequences might include

  • a feeling of being unlovable, unworthy of anything positive or good in life. The person might feel incompetent and inadequate.

  • The child might be unable to know whether they can trust themselves or others’ thoughts and actions.

  • They might have internal dialogues that are mainly made up of negative statements, as well as thinking that everyone is looking and talking about them in a negative way.

  • Their confidence might be very low and be very critical of themselves.

  • They might develop unreasonable expectations of themselves that will lead them to the vicious cycle of being critical and putting themselves down.

  • They might also develop obsessive-compulsive and/or addictive behaviours to numb down their feelings of inadequacy and to try and control negative thoughts.

Emotional consequences might include

  • Feeling discouraged and fearful of making mistakes.

  • Feeling anxious in social situations or when performing tasks.

  • Feeling fearful of rejection and of making mistakes.

  • Shutting down their emotions altogether, and having “self-esteem” attacks.

Lastly, low self-esteem might show up as behavioural issues such as

  • Defensiveness or aggressiveness

  • Eating disorders

  • Hypervigilance

  • Perfectionism

  • Being a harsh judge of him/herself

  • Self-sabotaging

  • Not being him/herself – putting on a persona or a mask to hide away their feeling of inadequacy and unworthiness.

All of the above can be worked through, and with the right interventions, the child or adult with low self-esteem will learn to be more assertive with themselves and others, and have a more positive outlook on life and on their abilities. This will be the topic of next week’s blog post: how therapy can help and how different modalities might help someone work through their self-esteem issues.

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For now, I leave you with a few more tips on how to help your child overcome their low self-esteem.

  • Accept the things you can’t change, and play to your strengths!

    • Model this for your child.

    • Sometimes we might want to do something that is outside of our range – for example, I would love to be able to play tennis professionally, but after attempting it a few times, I know that’s an unrealistic expectation of myself. I look like I’m hitting piñata and it is a bit embarrassing to say the least! I am happy to no be a professional tennis player though, and will find something else I am good at – professional bowling was something I did in the past, and would love to do that again. I enjoyed it and was really good at it!

  • Focus on the positives

    • As in my example above, focusing on what I can do – play bowling well – helps me build a positive self-image of myself and not put myself down for being awful at Tennis! I am allowed to be awful at some things and that is absolutely fine by me!

  • Help your child function in the real world

    • Teach your child that their actions have consequences, whether positive or negative.

      • They have a responsibility for their actions, whether good or bad ones.
    • Allow space for your child to think about their actions, and maybe even model your thinking about a decision or choice you made recently and how that affected you and others around you.

  • Challenge negative thoughts and behaviours

    • Your child might be telling you how they feel about themselves either verbally or through things they are doing.

    • Talking to your child about what you are seeing, in a caring and empathetic manner, will help them think differently about their negative views of themselves and slowly begin to see that if you don’t believe that about them, it might not actually be true.

    • Help your child change their behaviours by pointing out alternatives, for example, when learning to ride a bike, your child might have an unrealistic expectation that they will master this skill on the first try. They will most likely fall without training wheels or help, won’t they? You can tell your child about putting training wheels and asking for help to start with, like you did when you were a kid. Asking for help is a good thing! But they need to believe that it’s Ok to ask for help and not be perfect all the time. Small steps, more realistic expectations, will lead to success and increased self-esteem.

Until next week….

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In Therapy: Working through low self-esteem issues (part 1)

In Therapy- Working Through...

Welcome to this week’s In Therapy post!

I have decided to start with an important issue that parents might face. The idea to start with a topic related to children came up when I saw a post in a Facebook group – Parenting kids with Dyslexia/Dyspraxia/SPD/ADHD Sussex.

I work with children on the Autism Spectrum, Down’s Syndrome, and other Learning 3Disabilities, and I can see the stress – and distress – that parents sometimes go through due to their children’s health and additional needs. So working through issues with young people and children, and of course their families,  is right up my street!

I shall address topics around Autism in a future post. For today, and the following weeks, I want to focus on children with learning difficulties such as the ones the parents in the Facebook group above might be living with.

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So let’s get right into the topic of self-esteem.


What is self-esteem?

The dictionary defines self-esteem as a confidence and satisfaction in oneself; self-respect. It is how we judge ourselves and how we feel about ourselves.

When our self-esteem is at a positive level, we are motivated to achieve, to be ourselves out in the world, to look after ourselves and use all our resources to grow and get what we want out of life. People with healthy self-esteem have a good opinion of themselves. They know they have accomplished in the past (be it in school exams, in making their friends laugh, and in other areas of their lives), which tells them they can do it again.

On the other hand, when our self-esteem is low, we might feel unworthy, incapable, and stop doing those things that would benefit us, like having a shower as a way of self-care, or going out with our friends. Low self-esteem might be a result of other mental health issues such as anxiety or depression, which need to be paid attention to when working through this issue.

1So what happens when your child has low self-esteem related to ADHD, SPD, Dyslexia, Dyspraxia?

How does neurodiversity – neurological differences – affect your child’s self-esteem?

How do we work through low self-esteem issues in children that struggle with “mainstream” ways of doing things, like staying in their seats for most of the day, or their way of learning is different and they need extra support, or they perceive things differently from others?

What is going on emotionally for them? Are they seeing their differences as a negative? Have they been bullied because of their needs?

Children with ADHD might be corrected and/or punished more than others due to the challenging behaviours they might present as a result of the frustration at having to follow certain rules at school or other social situations. These corrections and punishments slowly lead the child to believe they are not good enough, incapable of doing school work or even incapable of being loved.

4Children with dyslexia, dyspraxia or SPD might be in a similar boat – they process things in a different way and in different timeframes than mainstream children. They also might need one-to-one support which might make them feel “different”. They might also get frustrated and display challenging behaviours as a result, leading to being reprimanded in some way.

Parents and teachers can do a lot to help their children, and it doesn’t have to be too taxing or difficult. Below I leave you with a couple of tips. More to come next week!

A couple of practical tips to work through your child’s low self-esteem:

  • Show your child that they are loved by
    • Praising what seem like small accomplishments – they add up!
    • Physical touch – hugs, kisses, pats on the back openly show your child that they’re loved and safe
    • Support your child in making decisions for themselves – being autonomous and successful at it will help develop a good image of their abilities
  • Model the fact that we won’t be right or know everything all the time
    • Show your child that you make mistakes and that you can work through it and still be confident in who you are
    • If you don’t know the answer to something, be honest and accept that you don’t know, and that it’s ok not to – grab a book or Google and research it with your child

I hope you have enjoyed the first instalment of In Therapy: Working through low self-esteem issues. Next week I will be adding some more tips to the list on how to help your child increase their self-esteem.I will also discuss the causes and consequences of having low self-esteem.  Finally, in a third and final post on Self-Esteem, I will talk about how different therapies might work through this issue with their clients.

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