Does the setting of therapy matter?

Recently I decided to seek private counselling. I made this decision because I felt it was something I desperately needed to break the cycle of being unwell mentally, and to address a number of issues that have built up over the years. I decided to seek a private counsellor for the following reasons:

  • The waiting period for an NHS appointed counsellor, if you qualify, is 6- to 12-months, and I’m not willing to wait.
  • NHS treatment is often limited to 6 sessions maximum and focussed on CBT, a treatment I have had several times which has only helped in the very short term.
  • The counsellor you see may not be a good fit for you, but you don’t get a choice, you have to work with that person or go back on a waiting list.

I wanted to be sure that I felt comfortable with a counsellor and wouldn’t be forced down the CBT road nor be limited to 6-sessions which causes all sorts of anxiety if you’re not feeling like you’ve made progress. Going private is an expensive option, but one I think is worthwhile because it’s my health at the end of the day and can you really put a price on that?

But this actually got me thinking, again, about something I’ve thought about before. Does the setting of these type of talk therapies, CBT included, make a difference to how well the treatment works or how comfortable someone feels in opening up and being involved in their care?

In my experience, with NHS treatment you are generally seen in quite a clinical setting. You’re sat in very uncomfortable chairs in a room normally used by a GP so there’s an examination bed/couch, a desk and computer, scales, and all manner of books, leaflets, and other information notices. Even when I’ve had CBT and brief counselling through my employer’s occupational health service, the setting isn’t much different to that of the NHS.

Privately, the setting is very different. It’s much more like sitting in a friend’s lounge on a sofa and having a chat over a cup of tea. There’s nothing clinical about this environment, it’s nicely decorated and comfortable. It just feels better, more relaxed.

So I’m wondering, does the physical setting make a difference in how people interact with talk therapies? Do you relax more and feel more comfortable in one or the other? Does it make a difference to whether they make progress or not? I’m genuinely curious. I don’t know if this is actually measurable, though I’m sure there’s plenty of anecdotal evidence.

What are your thoughts? Have you experienced any type of talk therapy in these different environments? If so, do you feel one was better than the other or is it more down to all the other things like the person you’re talking to, the type of treatment, the issue at hand?

NB I’ve left out group therapy as that’s a different thing altogether, and I have no personal experience of it so don’t feel I can comment.


A day in the life… 10 February 2015

The following is the unedited version of the A day in the life… post I submitted for the mental health blog project for 10 February 2015. I don’t know if that post will be published, but this is the full version of what I submitted (I had to cut it down by over 50%). It’s a bit long, but I think it gives you an idea of the way the thought processes happen when someone is experiencing stress and anxiety. 

Quick bit of background… suffered from depression on and off over the last 20 years (if not more) add to that the anxiety that often surfaces as the depression wanes, the constant state of worry and stress that seems to be my normal state, and I can now add ME/CFS to my portfolio of long-term conditions. Hooray.

My ME/CFS seems to be stress-induced so learning to manage my stress and anxiety is very important but my system is so weakened right now from two-and-a-half years of near-constant stressors it doesn’t really take much for me to relapse into depression, anxiety, and severe fatigue.

So today, Tuesday, 10th February I’m trying to muddle through the day feeling very tired and very anxious. Despite the fatigue, I struggle to sleep through the night so wake up many times. Last night was a typical night. I turned the lights out around 11pm and was probably asleep within 20 minutes, but between 1130pm and 650am, I woke up 3 times on my own accord, and one further time due to an inconsiderate neighbour. Each time I woke up I couldn’t get back to sleep for at least 30 minutes. I wondered what time it was, how much sleep I was losing, and how on earth I was going to manage at work. I was definitely going to cancel my social plans. So much for that work/life balance.

Then I started thinking the dark thoughts.

What is the bloody point of life? Everything requires so much effort, and I can’t even manage bog standard things like sleeping let alone bathing, eating well/regularly, exercising, keeping my home tidy, having a physical relationship with my other half, hobbies, etc., etc. So again, what is the bloody point if everything is a struggle? What if this relationship fails? What if I lose my job? Maybe I’ll just move home. I don’t care if I’m a 40-something year old, I just can’t be bloody bothered taking care of myself and putting in effort to do much of anything. Why can’t one single aspect of my life be easy and not require so much thought and effort? Absolutely everything feels overwhelming.

Maybe I should end things with my partner? I’m not worth the time or effort. I’ve gained a ton of weight, I can barely walk up a flight of stairs without feeling winded now. I have absolutely no interest in sex, holding hands or even kissing. I actually cannot stand to be touched by him. I tell myself this is because I don’t love my partner and am not attracted to him. I tell myself I was never attracted to him so why did I bother going out with him in the first place? Am I really going to move in with him in a few months? Why do I seem to be so bad at relationships?

I’m still trying to get back to sleep. I’m having conversations in my head with my partner, my line manager, the occupational health GP, the humans resources people. I’m apologising for being so useless. I’m trying to explain things.

Eventually I get back to sleep, but the neighbours alarm clock wakes me up at 0650. It goes off again 10 minutes later. And 10 minutes after that. The cat now wants out because he’s been woken up because I was woken up. I am feeling so tired from a night of so little restful sleep, so much anxiety from my own thoughts, dream upon dream that can be described as nothing other than anxiety dreams. I am trying to figure out what excuse I can make to avoid going to work, or at least how I can minimise my exposure to the office. I can find no way to do this since I’ve got meetings scheduled with occupational health and human resources regarding my health and capability for work. (No wonder I’m so full of anxiety and worry.)

I fall back asleep for another 90 minutes. I get up around 0845. This is closer to when I was due to wake up anyway. I get out of bed and tell myself to get into the shower. I fight with myself about this. ‘But you showered yesterday, and washed your hair, you could get away with not showering since you did fuck all yesterday’. I decide to shower anyway, it will help to wake me up.

I’m now showered. I feel a bit more awake. I get dressed, I eat a small bowl of cereal. I check I have put everything in my bag that I need — wallet, work notebook and papers, security badge to get into the building, papers from the ME/CFS clinic to take to my two health-related meetings. I decide to cycle to work. I used to be an avid cycling commuter, not a fair weather cyclist by any means, but over the last two years that has waned. This is the first time in a month I’ve been on my bike. I go slow. My joints hurt. I’m tired and I’m only halfway there. I think about stopping at the bus interchange and getting a bus the rest of the way in, but this would still mean a big walk at the other end. I push on thinking about how hard cycling home will be — all those hills.

I get into work and everyone is in. My heart sinks as I remember that I’ve left my iPod charging at home meaning no music to help me focus on my work and not be distracted by all the sounds of the office. One member of staff who only comes in once a week walks in. She vocalised every thought, speaks to her computer and phone, and generally grumbles about everything. This is going to be a long day.

My occupational health meeting is just before lunch. It’s a GP who’s handling my case. I bumped into the woman who previously handled it  and said a few very kind things to me. She acknowledged that some recent issues I had with work shouldn’t have happened and have exacerbated my health problems. Now if only the people making the decisions could understand this. The GP was brief, almost like it was a regular surgery appointment but this appointment allowed up to 30 minutes. I felt rushed. I wasn’t able to convey the problems I’m still having with work making decisions for me instead of including me in the decisions, or understanding that some of their processes and decisions are causing me further anxiety and stress leading to a relapse in fatigue. He did agree with the changes that I’ve implemented to work only part-time for the time being was a good decision; and said that the increase back to full time shouldn’t be rushed. At least I know there is support there.

I had to go into town to get lunch and collect an order. The lunchtime crowds really bother me so I avoid going to town normally. I just kept my head down and got what I needed. I made healthy choices for lunch, but bought snacks that I really shouldn’t have given they’re ladden with salt and sugar that I don’t need.

I had my meeting with HR after lunch. It started off OK, but was they mentioned that I’d obviously had some problems with my attendance recently so they wouldn’t look at ‘data’ regarding my working ability. I told them why I have had a recent relapse that has caused absences. The situation at work took many months to resolve causing a lot of stress, but they didn’t want to hear it. I was told it was all my fault. They didn’t want to hear that there was an issue with policy, only that the situation was my own fault. I’m feeling let down, again, frustrated and angry about it. Just when I was beginning to let it go.

Luckily the meeting finished near the end of my workday anyway so after tidying up a few things on my desk and replying to a couple of emails I was able to leave. It was a very unproductive day at work and the last meeting with HR has left me demotivated again.

Afterwards I spoke to a very good friend and colleague about the meeting and what was said. It left him feeling outraged on my behalf. We both continue to be surprised at how poorly things are handled for those of us with invisible illnesses. We joked about going home and cutting off a leg.

Cycling home was even harder than I thought it would be. I had to get off and push at the first big hill. After that I managed to stay in the saddle  in the lowest possible gears going at a very slow pace. It took me almost 45 minutes to get home. This is 15 minutes slower than when I’m moderately fit. I was proud of myself for not giving up and getting the bus home, and for cycling up most of the hills.

It’s nearly 7pm and I need to think about dinner. I’ve been thinking about dinner for more than an hour actually, but I’m nowhere near a decision. There’s food to be eaten in the fridge but the temptation to get a pizza delivered is really strong. I’ve already snacked on fudge… I’ve decided on an easy dinner of a quesadilla and salad.

It’s been a long and emotional day so I want to go to bed early-ish, but it’s difficult since I know I’ll wake up far too early if I go to bed too early. I can’t ever win!

Post depression anxiety

After every bout of depression that I overcome, I end up with anxiety issues. At times they’ve been crippling and become serious problems of their own as they lead to panic attacks and social phobia. This bout of depression has been no different and I’ve been lumbered with trying to get past the anxiety and ‘habits’ that have developed during this period. And just like this bout of depression that has manifested itself differently in the physical sense, so too has the anxiety.

I’ve not had the racing heart that leads to a panic attack, nor have I really had the social phobia. Instead I’ve developed some sort of anticipatory anxiety. I think it’s something I’ve always got (I’m a worrier by nature), but can usually control it without too much effort.

Every single day I wake up and I’m worried about how I will manage the day. I worry that I didn’t get enough sleep or the quality of my sleep was poor so I’ll find it difficult to function and stay awake. I worry that the slight pressure I feel behind my eyes or stiffness in my neck is going to become a full blown, crippling headache that will spiral out of control and lead to days of endless headaches followed by a headache hangover that will last several more days. I worry about aches and pains, and are they going to lead to other serious bouts of physical incapacity like I experienced three years ago.

And so I take it easy. I play it safe. I don’t want to rock the boat so I rest, and I rearrange meetings and readjust my working hours. I forgo social invitations and even basic self care like eating well and bathing.  Of course this leads back to those feelings of guilt and that I’m lazy, which means I don’t actually rest because I’m too busy listing all the things I should be doing but I’m not.

I feel trapped and paralysed by this anxiety. I can’t break it’s spell. I tell myself that if I just get up and get going everything will be OK. Getting bathed and dressed and fed will make me feel human and like nothing is wrong (and this is quite true). But some voice bubbles up from underneath all of this and tells me no, lie in, go to work later, take the strong painkillers and rest of the aches and pains. And I give into this voice because it is effortless to do so and I feel like everything takes more effort than it really should. It means that every night when I turn out the light and tell myself that tomorrow will be different, that tomorrow I’ll get up without any fuss and bathe and eat, I’m inevitably lying to myself as nine times out of ten, the voice tells me to take the easy road.

And the cycle continues. Unbreakable.


Reblogged: 6 Tips To Get Motivated When You’re Feeling Depressed

Actually some good advice that’s not condescending.


I’d make a terrific Catholic

When it comes to feeling guilty, I can say that I have well and truly mastered it. I think I probably mastered it early on in life. There are pictures of me as a child where I look solemn when the situation didn’t call for looking that way — I think it’s just how I physically express my feelings of guilt.

And my feelings of guilt aren’t ‘Oh I ate entire box of chocolates’ (OK, sometimes they are), but guilt for things which I often have no control over. This past week I had an email exchange with my mother who is recently retired. She discovered that many of her contemporaries have giant nest eggs while she has the smallest nest egg as she had to restart her savings/retirement planning several times in life for various reasons. She survives on her feeble savings, and a very small stipend from the state. Her friends are shocked that she can manage to live on so little. I ended up feeling incredibly guilty about her state of affairs. It also makes me extremely anxious about my own affairs.

She’s not struggling to the point where she’s going hungry or avoiding using the heating/gas, but when things come up — a new boiler, unexpected repairs to the house, etc. — it does hit her hard. I didn’t have anything to do with her state of affairs yet I feel somehow responsible. I was able to quickly get myself out of that funk by reminding myself that she’s had some very tough times in life, and had to make some hard choices, but I wasn’t responsible for those things. Unfortunately, it just led me down the slippery slope of self loathing and finding other reasons why I should feel guilty.

Frankly, it ruined my already shitty weekend. I was already having a mentally unstable Saturday, and this occupied my Sunday.

I felt guilty and inadequate for where I am in life. I’m unmarried, no children, I rent, I have a smallish pot of savings, I have a 10 year old car and a 15 year old television, and a wardrobe full of clothes that don’t fit because I keep gaining weight. My pantry and fridge are bursting with food yet there’s nothing to eat so I resort to toast, ice cream, and endless cups of tea/coffee. I felt guilty because all the things I said I’d do this weekend — bake, cook a real meal, finally go swimming, vacuum/mop the floors, not sit in front of the TV watching TV just because it’s there, no excessive napping — didn’t happen. I failed on all counts. I also didn’t bathe. I did manage to do three days worth of dishes so that’s something I guess.

It started off well on Saturday morning, getting up on time as I had an appointment first thing (don’t think for a minute I didn’t try to think of ways of getting out of this appointment without penalty). But by lunchtime, all my plans had gone out the window. I was firmly back in bed having the first nap of the day. I awoke feeling more tired than when I laid down, yet I had managed to fall asleep with little effort. I began to panic as I had another appointment that afternoon. It required me to drive quite a distance, but I wasn’t really feeling up for it. I started feeling guilty. I was going to have to cancel at the last minute. There was no way I could actually safely drive. I dislike driving at the best of times, and find it tiring, so this situation was definitely beginning to feel like it was totally out of the question. I got in touch and said I wasn’t feeling well. Luckily the person was extremely understanding and said if roles were reversed, they’d be feeling the same way (they suffer from Crohns). Relieved, I went for nap* number two.

From Jillian Fleck's Tumblr -
From Jillian Fleck’s Tumblr –

I felt slightly better, but still guilty. People had made special arrangements to accommodate me and I wasn’t even going to turn up. Worry not as I beat myself up about it all night. I watched TV that didn’t need watching. I eventually went to bed, taking one of the sleeping tablets my GP prescribed me, and went to sleep. Sunday morning I woke up determined things would be different.

Things weren’t different. In fact, they were possibly worse. I wanted nothing more than to escape. I felt like I’d let everyone down, even people not involved! I was thinking about talking to my boyfriend and telling him he’d be better off without me, and to find someone who wasn’t so bloody lazy and such a downer. I spent Sunday having my very own pity party.

Despite feeling like I’d let so many people down in such a short time, it really boils down to the fact that I’d let myself down, again. I, once again, took the easy route. I keep telling myself that I need to push myself a bit more, that I can’t just take the easy route all the time. Nothing will change if I continue to do that. I must find ways to take charge of my life, and motivate myself. I know that there would be positive changes in me if I got up and exercised. I would feel better about my physical appearance, and I’d have energy that I know I don’t have due to weight gain (it’s incredible what an extra 10lbs** can do to you physically). It would help me set a routine which I desperately need right now.

So that’s how my weekend went, how was yours?

* When  does it stop being termed a nap? I mean, nap two lasted nearly 2.5 hours! That’s a sleep really, right?

** 10lbs hahaha as if. More like 20lbs.


Tourist of the world

I think this is something a lot of us with mental health illnesses need to remember. I think we try to affect big change in our lives/world and it only makes things harder.


From Humans of New York, obviously.


One of those days

I’d like to say I have ‘one of those days’ only occasionally, but I seem to have them a lot. I’m talking about one of those days where I’m actually not tired for once, I feel rested. Yet I find I have this incredible urge to pull the curtains tight, lie down, fall asleep, and not wake up until I’m ready. I think it’s down to a combination of guilt and feeling overwhelmed. 

Guilt from not following my new regime. Guilt from not being as present at work as I could be. Guilt from not being as productive at work as I could be. Guilt from the all the outstanding chores at home. Guilt for not keeping up with keeping the garden in good order. Guilt from not exercising as much as I should. 

I could go on. So much guilt. So much guilt that adds up to nothing in the long run! I know I won’t eventually get to a point where I say ‘I wish I kept the grass cut and dusting under control’, yet I beat myself up about it! 

And then the guilt leaves me feeling overwhelmed. There are so many things I ‘should’ be doing but I’m not and I don’t know where to start. And who cares anyway, it’s not like I’ll ever get on top of them. 

Which of course leads to the urge to hide away and hope I feel differently when I emerge, or that some little fairies have come and taken care of everything for me (or at least some of the things).

I’ve bought another self help book … Getting things done – how to achieve stress-free productivity. I’m hoping that it really does help me get a grip. 


Too much worry

I have always been a worrier. It’s never been a worry about what people think of me, or how I’m dressed though sometimes those things come into pay, but a greater worry about the wellbeing of people, animals, the planet. I get so frustrated when I see people being inconsiderate towards others when there are some really simple things they can do. I do take into account that these inconsiderate people have their own things going on that I’m not aware of so I’m not super critical of them, I just get frustrated with the complacency of others.

For example, I live in an area with incredible kerbside recycling facilities — there’s very little we can’t put in our special recycling bins right on our doorstep — yet I see so many people in my neighbourhood either recycle sporadically, or just treat the special bin as a second landfill bin. I understood more about people not recycling when it was inconvenient – having to store and haul your recyclables to potentially different locations is a pain, but it’s so easy now, why don’t people do it? Some people feel it’s ‘big brother’ and they should be allowed to do what they want. It’s an odd selfishness that I don’t understand at all and it really occupies way too much of my time getting myself worked up about the way others behave.

I try to step back and think that I can do what I can do to reduce my impact on the planet, but then I look at what others around me do and feel so much despair (I can actually feel my heart rate increasing as I type this) that people can’t see beyond the end of their noses how their actions affect other people/places. Why should it all be left up to people like me with a consciousness about our impacts? I know some of it is down to knowledge/education, but I know plenty of people who are well aware of these things but make no changes to their behaviour.

I get to the point where I start to think ‘What’s the freakin’ point of you being so concerned about these things, recycling every little scrap of paper, beer bottle top, etc. when so few around you do nothing? Why don’t you just give up and follow the status quo? You’d probably be happier since you wouldn’t be worrying – you’d be blissfully ignorant.’ But I can’t seem to do this. I can’t seem to not care about the environment/sexism/animal welfare. I end up feeling guilty about digressions. And there are so many campaigns about every cause now that I’m inundated with the latest atrocity several times a day via Twitter, Facebook, email, and various news outlets. I can’t escape it.

How do I continue to live by my ethics yet not get all het up when others don’t show the same concern as me when they have the same access as me to things like recycling or public transport? Getting het up just leaves me angry, frustrated, and in despair that things will never improve. And I am very well aware that this causes me mental anguish that will eventually lead, yet again, to a spell of depression. (As I said, I do cut people slack in many ways since I don’t know their whole story — e.g. the woman around the corner that works in the same building as me yet drives into work instead of taking the bus when there are literally dozens of options for her. While yet she complains about having to go in extra early because of traffic and the price of parking her car everyday, she may have very good reasons for driving instead of using public transport.)

I need to find ways to do my bit for the things that are important to me, and not get angry and frustrated with others not practicing the same ethics as me. Any ideas? I guess the first is to unsubscribe from all news feeds on Twitter/Facebook, and see what I can do to manage the emails, and avoid the news on TV/papers/online as best I can. It’s so easy to get sucked into these stories and become enraged, and then have no real outlet for that rage.

I could go on in a rambling sort of way as I have, but I’ll end here. If you’ve any ideas on what I can do to keep myself living my ethics, but also not feeling guilty  if they slip or I can’t keep up with them, then please let me know!


Mental Health Awareness Week: Why is awareness so important?


I’m not sure if you’re aware, but this week is Mental Health Awareness Week. For those who spend much time around me, this must sound rather exhausting. Barely a week goes by where I don’t moan about my symptoms, complain about stigma, or behave in a generally ‘mental’ way. Rather than another week of raising awareness, I suspect many of my friends would prefer a Mental Health Ignorance Week. Where I’d be induced into a state of quiet normalness, and the rest of the world could continue… Well… pretty much as normal.

"Ignorance is bliss" “Ignorance is bliss” (This is one of my favourite pictures on the internet – I don’t know the original source)

And – if I’m fair – I’d have sympathy. For a start, I know how boring I can get when I feel motivated to speak. It’s like a terrible episode of Question Time, where the most annoying…

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Dark thoughts: why mental illness is on the rise in academia

Dark thoughts: why mental illness is on the rise in academia