Tag Archives: counselling

Therapist with client

How can counselling help physical health problems?

Sick female on sofa with paramedics and concerned friend

There are countless people suffering everyday with symptoms that are medically unexplained. They may have a label/diagnosis but insufficient explanation as to what is actually going on to fully manage it. These are often managed with medication such as painkillers or anti-inflammatories, or patients simply have to try and put up with them having received a half-hearted explanation from their primary care physician. Examples include non-cardiac chest pain, tension-type headaches, globus-syndrome, chronic fatigue syndrome, non-epileptic seizures, candidiasis hypersensitivity, chronic pain syndromes, irritable bowel syndrome.

When a patient goes to their primary care physician for a physical symptom they should, of course by investigated to see if the symptom is caused by a physical health problem. For example, if you have difficulty swallowing, the physician will first take a full history, then your throat will be examined and further tests/scans etc will be done to discover any pathophysiology . Differential diagnoses could be gastro-oesophageal reflux disease (GORD), stroke, multiple sclerosis and various cancers. But if all of these are ruled out by the time the various tests are finished the most important thing is not to dismiss the patient’s symptom! How many of us with chronic symptoms have had various tests come back as “all clear” and thought—so what next?! I’m still suffering…how do I manage my symptom(s)?!

Female on floor with blanket blowing her nose

Research has shown that 52% of adult referrals to rheumatology, cardiology, gastroenterology, neurology and gynaecology have no known pathology linked to that speciality and are therefore discharged from that speciality without a management plan. This happened to me when I was referred to rheumatology—I received a half-hearted diagnosis of fibromyalgia, was told there might be a leaflet in the waiting room I could pick up on my way out and that was that. No treatment options, no plan, no hope.

It can be very difficult to see how a very physical symptoms can have any psychological component but the mind is an incredibly powerful organ. It controls everything that happens in your body. Day-in-day-out, unconsciously, your mind controls digestion, metabolism, your heart rate and respiration. You don’t consciously think “breath-in…breath-out…” but your body just does it. However, you can choose to slow down or speed up your breathing, take a deep breath or hold your breath if you want to. It’s also been shown that being aware of your heart beat can be effective during times of anxiety when you need to calm yourself down, you can consciously slow it down.

If you want to manage physical symptoms, a helpful exercise can be to think about where you feel emotions. For example, most people feel, at least a little workplace stress—where do you feel this? Do your shoulders feel tense? Does your chest feel heavy? Do you feel a knot in your abdomen? Noticing how your emotions impact your body is an important start on the road to getting your mind and body re-connected.

Another helpful processes is to think about when you first started noticing your physical symptoms. For example, did you experience a bereavement, a period of work stress, bullying, car accident or other trauma? Once identified, considering how you managed this event is key—do you think you’ve fully processed it? Don’t compare yourself to others, everyone deals with life’s events differently. Do you think there’s a pattern to how you deal with things? Are you a stiff-upper-lip type? Or do you busy yourself with helping others? Perhaps some things feel too painful to process? Noticing these patterns and considering what impact this could be having is important. If we don’t process stressful events, the stress needs to go somewhere; the tissues in your body will hold onto it until your consciously choose to release it.

Male on side of bed with head in hand

Not processing events fully can lead to shame and guilt. Holding onto these feelings becomes a negative cycle that can impact every area of life.

You may feel that your physical symptoms come and go randomly with no connection to anything and despite trying to find triggers. The body is amazing at holding onto stress and releasing it at a later date. For other people the body provides an early warning signal that your under stress. Counselling can help you become more aware of your emotions and how you process them. It can also help you becomes more in tune with your body, which, in turn, will improve your physical health.

If you’re not yet convinced that the brain-body connection is important, take a look at this study (Suzanne C. Segerstrom, Ph.D., et al.), it shows that law students who were confident had more and better functioning immune cells than worried students. This systemic review and meta-analysis (Alan Rozanski, MD, et al.) also showed that optimism was associated with lower risk of cardiovascular events.

During these difficult times, people are struggling with all sorts of unusual experiences and are dealing with untold pressures, don’t downplay how hard you’re finding it! It’s been shown that talking is one of the most important things we can do, whether this is to a trusted friend or to a professional counsellor, making the first step will be the hardest but it will benefit every aspect of your life.

female video call

How to find the right counsellor for you

I’m currently training to be a counselling. As someone who’s also experienced “lying on the therapists couch” I thought I’d put some thoughts together for people who might be looking for a counsellor or therapist in these difficult times.

If you were looking for a doctor, you would make sure they were registered with the General Medical Council. Therefore you should make sure that your therapist/counsellor is a member of an organisation such as: BACP, UKCP or NCS* (or equivalent in other countries). The counselling/therapy profession isn’t currently fully regulated (that means anyone can call themselves a counsellor and isn’t breaking the law)…but by making sure that they’re a member of an organisation such as these, you’ll be getting a professional who:

  • Has achieved a substantial level of training (at least diploma level having undertaken 100 hours supervised placement hours etc)
  • Frequently undertakes continuous professional development
  • Adheres to a specific code of ethics (which can be found on each website)

You may wish to use a directory such as Counselling Directory to search for a verified, accredited counsellor/therapist. We have been incredibly fortunate that counselling has become more accessible recently, it’s now available online or on the phone, although there may be pros and cons, see this recent blog. There are specific platforms where this is all that’s offered so that it’s available across the world (e.g. Better Help and My Online Therapy). However, location may be a priority, should you wish to return to face-to-face counselling at some point. When browsing profiles a few red flags to beware of:

  • A counsellor who claims they deal with too many areas—some very experienced counsellors may have expertise in a number of areas but watch out for inexperienced counsellor’s who’re just trying to look more attractive.
  • Offering too many therapies—integrative is a type of therapy that is a specific way of blending therapies but being a specialist in more than about 4-5 therapeutic interventions means the therapist may not know the therapies in any depth. Also beware of the opposite—very specialist therapies claiming to cure-all are spinning you false hope!

Before you go to meet you counsellor/therapist, try to be clear with yourself what you want. For example, they don’t/shouldn’t diagnose or offer advice, the sorts of things you might achieve involve understanding yourself and why you repeat unhelpful patterns better and developing more helpful ways of coping with life’s ups and downs. It’s not up to them to decide what you need. During the introductory session, it’s important to find out if what you want and what they offer align.

Once you meet a therapist, you may think that feeling a sense of connection is the most important thing; while you’re not wrong there are some other important points to consider:

  • Do you trust them to keep the boundaries? These are the framework on which everything else hangs—they help you maintain trust and they’re where the work begins! For example, if the sessions always run over time, do you trust them to maintain confidentiality?
  • Will you be able to form a working alliance with this person? This is the relationship that exists between the counsellor and client that means they are able to work together in a judgment free zone towards shared goals. Do you understand how they work and will this help you?
  • Will this person challenge you? If you feel too comfortable with this person, if they’re too similar to you, it can be difficult to push yourself outside your comfort zone and make the changes that are needed.
  • Have you been able to ask all the questions you have? Do you know how much it’s going to cost? Are you signing up for a specific number of session or is it open ended? How will you be reviewing you progress?

Obviously you don’t want things to go wrong but if at any point you’re uncomfortable or wonder if they’ve behaved unethically, have they told you what to do? (Speak to them initially, then contact their membership body.)

Counselling/therapy can be hard but fantastically rewarding.

A life unexamined is not worth living—Socrates
  • *BACP = British Association for Counsellors and Psychotherapists
  • UKCP = UK Council for Psychotherapy
  • NCS = National Counselling Society
Lady using phone and laptop

Therapy in a post-covid world

Imagine you’ve been seeing a therapist once a week to help manage a mental health condition, then the COVID-19 pandemic hits your country and you’re suddenly in lockdown. Everyone around you is concerned with whether they can buy enough toilet roll, work from home, arrange childcare or finish buying the supplies for their DIY project; while these things are important to you, you’re world has been turned upside down because the one place you felt completely safe was your therapist’s room and you have no idea when you’ll be able to return.

There are a number of issues to consider when thinking about delivering therapy remotely, it’s important to think about keeping everyone safe:

  • Is the client’s space confidential? How comfortable do they feel? Might they be distracted/interrupted by other people/chores etc? This is particularly important for cases involving domestic abuse or relationship issues.
  • There are a number of options—phone, text only or video conferencing all have pros and cons for client and counsellor. Security of the software is a consideration as well as how the clients data will be managed.
  • It’s important to assess the psychological needs of the client, it may be inappropriate for certain people to engage remotely/virtually due to the type or severity of their problems—this needs to be handled sensitively.

For some agencies in March 2020 (when lockdown hit in the UK), their automatic reaction was shutdown, there was no way that they could function if they couldn’t meet their clients face-to-face. For their clients this could have hit them incredibly hard, they could have felt let down, even abandoned, past hurts may have been recreated. Of course, at ever point, risk assessments were carried out to try and meet the needs of the clients, check in calls were offered and referrals were made to ensure high risk clients could be supported by other services.

What are the pros and cons of virtual therapy and what does it really fell like?!

Not meeting a client face-to-face, obviously, a lot of the nuance is lost. Depending on whether the communication is on the phone, via video call or text based, you may lose body language, eye contact, facial expression or even intonation of voice. Experts say that 70-93% of language is non-verbal so you lose a lot when you’re not in the same room as the person you’re talking to.

young female looking sad texting

But everyone has been struggling during this global pandemic and it’s been vital for people with mental health difficulties to get support. So many therapists and counsellors have stepped up and sought appropriate training. It’s important to take the following into consideration:

  • From the client’s perspective, meeting in their home could feel invasive, or they may not be able to find a confidential space. However there could be benefits such as the client not having to commute. If, however, the client finds it difficult to wind down after a session, grounding exercises can be used.
  • The therapist may continue to use their therapy room but if they use videoconferencing in their own home, they need to consider what’s in the background (books? photographs? things they wouldn’t usually choose to disclose?). If the therapist chooses to use a photograph to conceal the background, how does that look to the client? What are they hiding?
  • It has been found that clients are less inhibited when remote from their counsellor, they will therefore find it easier to criticise the counsellor and will also talk about deeper issues more quickly than when they’re not face-to-face. The counsellor will need to be prepared for the former and it will be important to remember the client may feel vulnerable if the latter occurs.
  • When using phone or text only medium, it’s harder to use silence as a therapeutic tool. If videoconferencing, breaking the silence with “has the screen frozen?” isn’t particularly therapeutic!
  • Contracting needs to have additional consideration e.g. what happens if the technology fails? what do you do if there’s an interruption?
  • Counsellors need to be aware of the blackhole effect. This is the impact that occurs when a client disappears and is not contactable (what to do if this happens will need to be in the contract). Although this can bring up difficult feelings when the relationship has been face-to-face, it has been found the clients are more likely to do it when the relationship is virtual and the feelings that surface in the counsellor can be difficult to manage if counsellor is unprepared or inexperienced.
Lady on video call

I’ve wondered why it took such an extraordinary event, a global pandemic, to open up the world and ensure that people with disabilities could access work and services equally? It’s fantastic that remote counselling is now so widely used and so many more people are now able to access it but there’s a lot to consider.

It’s important that therapists and counsellors are confident in their abilities and fully trained as there are many differences between face-to-face and remote counselling. Since the world of counselling isn’t regulated, this is another layer that has required professionals and students to act responsibly with regards to our ethical framework.

If you’re looking for a counsellor, it’s more important than ever to ensure they belong to a regulate body, such as the UKCP or BACP and that they have suitable training if you’re going to meet with them remotely.